Provider Demographics
NPI:1942945233
Name:NELSON, STEPHANIE KRISTINA (RN, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:KRISTINA
Last Name:NELSON
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4246 N 96TH ST
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53222-1531
Mailing Address - Country:US
Mailing Address - Phone:847-951-9714
Mailing Address - Fax:
Practice Address - Street 1:4246 N 96TH ST
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53222-1531
Practice Address - Country:US
Practice Address - Phone:847-951-9714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-01
Last Update Date:2022-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI176381-30163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant