Provider Demographics
NPI:1528021003
Name:STEPHENSON, CAROL L (LPN)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:L
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 NORTH WATER
Mailing Address - Street 2:APT.#11
Mailing Address - City:PLATTEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53818-1435
Mailing Address - Country:US
Mailing Address - Phone:608-348-5760
Mailing Address - Fax:
Practice Address - Street 1:1516 DE VALERA
Practice Address - Street 2:
Practice Address - City:PLATTEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53818
Practice Address - Country:US
Practice Address - Phone:608-348-8369
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-07
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse