Provider Demographics
NPI:1366494205
Name:STEPHAN, VICTORIA JEAN (RN)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:JEAN
Last Name:STEPHAN
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 1:8836 CANARY CT
Mailing Address - Street 2:
Mailing Address - City:WIND LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:53185-5519
Mailing Address - Country:US
Mailing Address - Phone:262-895-7416
Mailing Address - Fax:
Practice Address - Street 1:8836 CANARY CT
Practice Address - Street 2:
Practice Address - City:WIND LAKE
Practice Address - State:WI
Practice Address - Zip Code:53185-5519
Practice Address - Country:US
Practice Address - Phone:262-895-7416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI93441-030163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39851900Medicaid