Provider Demographics
NPI:1790738631
Name:STUEFEN, MYRNA B (PAC)
Entity Type:Individual
Prefix:
First Name:MYRNA
Middle Name:B
Last Name:STUEFEN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4131 W LOOMIS RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53221-2057
Mailing Address - Country:US
Mailing Address - Phone:414-325-7246
Mailing Address - Fax:414-325-3770
Practice Address - Street 1:1400 MADISON AVE
Practice Address - Street 2:SUITE 402
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-5473
Practice Address - Country:US
Practice Address - Phone:507-625-7246
Practice Address - Fax:507-386-2599
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2014-04-28
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Provider Licenses
StateLicense IDTaxonomies
SD0399363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD970021572Medicare PIN
SDP00008844Medicare PIN
S62573Medicare UPIN
SDS8301Medicare PIN