Provider Demographics
NPI:1891260543
Name:BROWN, STEPHANIE M (APNP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:M
Last Name:BROWN
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6308 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53143-5031
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10256 OLD GREEN BAY RD FL 4
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53158-2814
Practice Address - Country:US
Practice Address - Phone:262-551-4210
Practice Address - Fax:262-551-4942
Is Sole Proprietor?:No
Enumeration Date:2018-10-09
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8765-33363LP2300X
WI8765363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1891260543Medicaid
WIK400519234OtherMEDICARE