Provider Demographics
NPI:1477736163
Name:OFFORD, STEPHANIE J (APNP)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:J
Last Name:OFFORD
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:J
Other - Last Name:GRUBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APNP
Mailing Address - Street 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:DIVISION OF GENETICS
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-266-2979
Mailing Address - Fax:414-266-1616
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:DIVISION OF GENETICS
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4874
Practice Address - Country:US
Practice Address - Phone:414-266-3347
Practice Address - Fax:414-266-1616
Is Sole Proprietor?:No
Enumeration Date:2007-12-17
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3305363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1477736163Medicaid
WI736011906Medicare PIN