Provider Demographics
NPI:1518433564
Name:STAHL, LAQUISHA M (NP)
Entity Type:Individual
Prefix:
First Name:LAQUISHA
Middle Name:M
Last Name:STAHL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LAQUISHA
Other - Middle Name:M
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1969 WEST HART RD
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-2283
Mailing Address - Country:US
Mailing Address - Phone:608-364-5689
Mailing Address - Fax:608-364-5452
Practice Address - Street 1:1650 LEE LANE
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511
Practice Address - Country:US
Practice Address - Phone:608-364-2200
Practice Address - Fax:608-364-5452
Is Sole Proprietor?:No
Enumeration Date:2018-10-17
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209018312207RN0300X, 363L00000X
WI9900-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology