Provider Demographics
NPI:1124526413
Name:STOWERS, BECKY LYNN I (BSN, RN)
Entity type:Individual
Prefix:MISS
First Name:BECKY
Middle Name:LYNN
Last Name:STOWERS
Suffix:I
Gender:F
Credentials:BSN, RN
Other - Prefix:MRS
Other - First Name:BECKY
Other - Middle Name:LYNN
Other - Last Name:ROELKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:840 20TH ST APT 4
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE DU SAC
Mailing Address - State:WI
Mailing Address - Zip Code:53578-2103
Mailing Address - Country:US
Mailing Address - Phone:608-334-4929
Mailing Address - Fax:
Practice Address - Street 1:1515 HOMMEN RD
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:WI
Practice Address - Zip Code:53531-9678
Practice Address - Country:US
Practice Address - Phone:608-444-0774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI90392163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse