Provider Demographics
NPI:1194294850
Name:COMPTON, STEPHANIE ANGEL (LPN)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANGEL
Last Name:COMPTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 8TH ST APT 214
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53403-1496
Mailing Address - Country:US
Mailing Address - Phone:262-994-5049
Mailing Address - Fax:
Practice Address - Street 1:815 8TH ST APT 214
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53403-1496
Practice Address - Country:US
Practice Address - Phone:262-994-5049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-24
Last Update Date:2018-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI322244164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse