Provider Demographics
NPI:1821425216
Name:SHULFER, STACY L (PA-C)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:L
Last Name:SHULFER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5449 PINEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54482-8818
Mailing Address - Country:US
Mailing Address - Phone:608-516-8225
Mailing Address - Fax:
Practice Address - Street 1:1881 COUNTY ROAD XX
Practice Address - Street 2:
Practice Address - City:KRONENWETTER
Practice Address - State:WI
Practice Address - Zip Code:54455-7933
Practice Address - Country:US
Practice Address - Phone:715-355-4040
Practice Address - Fax:715-359-8461
Is Sole Proprietor?:No
Enumeration Date:2013-10-01
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3159-23363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant