Provider Demographics
NPI:1194536334
Name:DAMICO-STANO, ELISE
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:DAMICO-STANO
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 1:2787 S AMOR DR
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53146-2304
Mailing Address - Country:US
Mailing Address - Phone:414-639-5239
Mailing Address - Fax:
Practice Address - Street 1:2787 S AMOR DR
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53146-2304
Practice Address - Country:US
Practice Address - Phone:414-639-5239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163149-030163WN1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN1003XNursing Service ProvidersRegistered NurseNutrition Support