Provider Demographics
NPI:1942861406
Name:WANEK, STEPHANIE (NP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:WANEK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33822 BUCKEYE LN
Mailing Address - Street 2:
Mailing Address - City:BLUE RIVER
Mailing Address - State:WI
Mailing Address - Zip Code:53518-8124
Mailing Address - Country:US
Mailing Address - Phone:608-604-2304
Mailing Address - Fax:
Practice Address - Street 1:800 COMPASSION WAY
Practice Address - Street 2:
Practice Address - City:DODGEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53533-1956
Practice Address - Country:US
Practice Address - Phone:608-930-7114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9308-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner