Individual
MICHAEL STARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
12049 44TH AVE, PLEASANT PRAIRIE, WI 53158-3927
(530) 562-5476
Mailing address
12049 44TH AVE, PLEASANT PRAIRIE, WI 53158-3927
(530) 562-5476
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
043133707
IL
164X00000X
Licensed Vocational Nurse
719020
CA
Other
Enumeration date
07/18/2025
Last updated
07/18/2025
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