Provider Demographics
NPI:1194999862
Name:STAGER, WENDY J (RN)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:J
Last Name:STAGER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6694 HILL RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GREENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53129-2720
Mailing Address - Country:US
Mailing Address - Phone:414-425-3528
Mailing Address - Fax:414-425-3528
Practice Address - Street 1:6694 HILL RIDGE DR
Practice Address - Street 2:
Practice Address - City:GREENDALE
Practice Address - State:WI
Practice Address - Zip Code:53129-2720
Practice Address - Country:US
Practice Address - Phone:414-425-3528
Practice Address - Fax:414-425-3528
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI66398-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39919000Medicaid