Provider Demographics
NPI:1851610612
Name:GESTRICH, STEFANIE L (LPN)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:L
Last Name:GESTRICH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8326 W STUART RD
Mailing Address - Street 2:
Mailing Address - City:ORFORDVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53576-9568
Mailing Address - Country:US
Mailing Address - Phone:608-931-3404
Mailing Address - Fax:
Practice Address - Street 1:8326 W STUART RD
Practice Address - Street 2:
Practice Address - City:ORFORDVILLE
Practice Address - State:WI
Practice Address - Zip Code:53576-9568
Practice Address - Country:US
Practice Address - Phone:608-931-3404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-19
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI312430-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse