Provider Demographics
NPI:1891260543
Name:BROWN, STEPHANIE M (APNP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:M
Last Name:BROWN
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 W CARDINAL CIR
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-6334
Mailing Address - Country:US
Mailing Address - Phone:262-748-7398
Mailing Address - Fax:
Practice Address - Street 1:3400 MARKET LN
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-3430
Practice Address - Country:US
Practice Address - Phone:262-551-4600
Practice Address - Fax:262-551-4630
Is Sole Proprietor?:No
Enumeration Date:2018-10-09
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8765-33363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1891260543Medicaid
WIK400519234OtherMEDICARE