Provider Demographics
NPI:1619328069
Name:BAILEY, STEFANIE J (APNP)
Entity Type:Individual
Prefix:MS
First Name:STEFANIE
Middle Name:J
Last Name:BAILEY
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:STEFANIE
Other - Middle Name:
Other - Last Name:JANSSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7330 W LAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53220-3849
Mailing Address - Country:US
Mailing Address - Phone:414-817-8896
Mailing Address - Fax:262-228-6257
Practice Address - Street 1:7330 W LAYTON AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53220-3849
Practice Address - Country:US
Practice Address - Phone:414-817-8896
Practice Address - Fax:262-228-6257
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7037363LP0808X
WIF06161979363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100061581Medicaid