Provider Demographics
NPI:1346570397
Name:FONS, STEPHANIE L (RN)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:L
Last Name:FONS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2935 S 95TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-3613
Mailing Address - Country:US
Mailing Address - Phone:414-559-7191
Mailing Address - Fax:
Practice Address - Street 1:2935 S 95TH ST
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-3613
Practice Address - Country:US
Practice Address - Phone:414-559-7191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-13
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI129486-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse