Wynn, Stephanie Rose

Wynn, Stephanie Rose is an individual health care provider with primary practice located at 6811 118Th Ave , Kenosha WI 53142-8420. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, Physician Assistants & Advanced Practice Nursing Providers / Family. Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner is her primary health care specialty. Wynn, Stephanie Rose can be contacted via phone (262) 857-5750.

Contact Information

Primary practice address
6811 118Th Ave Kenosha WI 53142-8420
Phone: (262) 857-5750
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 9103 Wisconsin
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 9103-33 Wisconsin

Profile Details

NPI number 1417415761
LBN Legal business name Wynn, Stephanie Rose
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 6th, 2019
Last updated Oct 17th, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1417415761 NPPES
Wisconsin MEDICAID 100097887

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