Provider Demographics
NPI:1386620847
Name:STERNITZKY, NICOLE L B (MD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:L B
Last Name:STERNITZKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:945 N 12TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53233-1305
Mailing Address - Country:US
Mailing Address - Phone:414-219-5541
Mailing Address - Fax:
Practice Address - Street 1:20611 WATERTOWN RD
Practice Address - Street 2:SUITE E
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-1871
Practice Address - Country:US
Practice Address - Phone:262-798-1910
Practice Address - Fax:262-798-8660
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI49347020207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34882600Medicaid