Individual
STEPHEN HANISEE PARK
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
S7208A YANSKE ROAD, VIROQUA, WI 54665-5466
(608) 675-3848
Mailing address
S7208A YANSKE ROAD, VIROQUA, WI 54665-5466
(608) 675-3848
Taxonomy
Speciality
Code
Description
License number
State
163WH0200X
Home Health Registered Nurse
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38237900
—
WI
01
—
R 136336-4
RN LICENSE
MN
Enumeration date
03/16/2006
Last updated
07/21/2022
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