Provider Demographics
NPI:1568837490
Name:OPAHLE, STACIE
Entity type:Individual
Prefix:
First Name:STACIE
Middle Name:
Last Name:OPAHLE
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 1:625 RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:COLGATE
Mailing Address - State:WI
Mailing Address - Zip Code:53017-9527
Mailing Address - Country:US
Mailing Address - Phone:920-213-8997
Mailing Address - Fax:
Practice Address - Street 1:W156N8327 PILGRIM RD
Practice Address - Street 2:STE 408
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-3776
Practice Address - Country:US
Practice Address - Phone:414-395-8106
Practice Address - Fax:414-386-0406
Is Sole Proprietor?:No
Enumeration Date:2015-12-03
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide