Provider Demographics
NPI:1780647917
Name:STABBE, MICHELLE IRENE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:IRENE
Last Name:STABBE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:MICHELLE
Other - Middle Name:IRENE
Other - Last Name:STABBE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:8348 FOLEY RD
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53402-9521
Mailing Address - Country:US
Mailing Address - Phone:262-639-1648
Mailing Address - Fax:
Practice Address - Street 1:8348 FOLEY RD
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53402-9521
Practice Address - Country:US
Practice Address - Phone:262-639-1648
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI31305-031164W00000X, 164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered164W00000XNursing Service ProvidersLicensed Practical Nurse
Not Answered164X00000XNursing Service ProvidersLicensed Vocational Nurse