Provider Demographics
NPI:1326293176
Name:STUKENBERG, ELIZABETH R (DNP, APNP, FNP-BC)
Entity type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:R
Last Name:STUKENBERG
Suffix:
Gender:F
Credentials:DNP, APNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OCONTO
Mailing Address - State:WI
Mailing Address - Zip Code:54153-1541
Mailing Address - Country:US
Mailing Address - Phone:800-242-7334
Mailing Address - Fax:
Practice Address - Street 1:1201 MAIN ST
Practice Address - Street 2:
Practice Address - City:OCONTO
Practice Address - State:WI
Practice Address - Zip Code:54153-1541
Practice Address - Country:US
Practice Address - Phone:800-242-7334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI171349-30163W00000X
WI6542 - 33363LF0000X
WI6542-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily