Provider Demographics
NPI:1760120505
Name:MOERSCHEL, STEPHEN DAVID (APNP)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:DAVID
Last Name:MOERSCHEL
Suffix:
Gender:M
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W COVENTRY CT APT 306
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-3959
Mailing Address - Country:US
Mailing Address - Phone:414-418-2817
Mailing Address - Fax:
Practice Address - Street 1:301 W COVENTRY CT APT 306
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217-3959
Practice Address - Country:US
Practice Address - Phone:414-418-2817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11978-33363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care