Provider Demographics
NPI:1811379225
Name:STOUT, DANA MARY (APNP)
Entity Type:Individual
Prefix:MS
First Name:DANA
Middle Name:MARY
Last Name:STOUT
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Gender:F
Credentials:APNP
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Mailing Address - Street 1:7401 104TH AVE STE 110
Mailing Address - Street 2:COMPREHENSIVE ORTHOPAEDICS, S.C.
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-7845
Mailing Address - Country:US
Mailing Address - Phone:262-764-5595
Mailing Address - Fax:262-764-9314
Practice Address - Street 1:7401 104TH AVENUE, SUITE 110
Practice Address - Street 2:COMPREHENSIVE ORTHOPAEDICS, S.C.
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142
Practice Address - Country:US
Practice Address - Phone:414-325-7246
Practice Address - Fax:414-325-3770
Is Sole Proprietor?:No
Enumeration Date:2015-06-22
Last Update Date:2015-12-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI158976163W00000X
WI6479-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
13577846OtherCAQH
WIK400237597Medicare UPIN