Provider Demographics
NPI:1396279022
Name:KNIECH, STEPHANIE M (PA)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:M
Last Name:KNIECH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225000 HUMMINGBIRD RD
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-2948
Mailing Address - Country:US
Mailing Address - Phone:715-359-6442
Mailing Address - Fax:
Practice Address - Street 1:225000 HUMMINGBIRD RD
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-2948
Practice Address - Country:US
Practice Address - Phone:715-359-6442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-19
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4024363A00000X
WI4024-23363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant