Provider Demographics
NPI:1750029880
Name:WUESTEWALD, STACI CHRISTINE (RN)
Entity Type:Individual
Prefix:MRS
First Name:STACI
Middle Name:CHRISTINE
Last Name:WUESTEWALD
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:PO BOX 645
Mailing Address - Street 2:
Mailing Address - City:PONCA
Mailing Address - State:NE
Mailing Address - Zip Code:68770-0645
Mailing Address - Country:US
Mailing Address - Phone:402-755-2552
Mailing Address - Fax:402-755-2387
Practice Address - Street 1:104 S EAST ST
Practice Address - Street 2:
Practice Address - City:PONCA
Practice Address - State:NE
Practice Address - Zip Code:68770-7264
Practice Address - Country:US
Practice Address - Phone:402-755-2552
Practice Address - Fax:402-755-2387
Is Sole Proprietor?:No
Enumeration Date:2022-05-27
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR051494163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health