Provider Demographics
NPI:1952756454
Name:STOCKHAUSEN, DANA
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:STOCKHAUSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 N 124TH ST
Mailing Address - Street 2:APT# 100
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-1069
Mailing Address - Country:US
Mailing Address - Phone:414-416-4220
Mailing Address - Fax:
Practice Address - Street 1:2520 N 124TH ST
Practice Address - Street 2:APT# 100
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-1069
Practice Address - Country:US
Practice Address - Phone:414-416-4220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-03
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI224560-30163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics