Provider Demographics
NPI:1255598140
Name:MAHAGA, STELLA M (NP)
Entity type:Individual
Prefix:MS
First Name:STELLA
Middle Name:M
Last Name:MAHAGA
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 1:8777 W FOREST HOME AVE
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53228-3421
Mailing Address - Country:US
Mailing Address - Phone:262-292-4777
Mailing Address - Fax:
Practice Address - Street 1:8777 W FOREST HOME AVE
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53228-3421
Practice Address - Country:US
Practice Address - Phone:262-292-4777
Practice Address - Fax:262-518-7052
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7261-33363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1255598140Medicaid