Individual
STEPHANIE ANNE MOMPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
N112W15415 MEQUON RD, GERMANTOWN, WI 53022-3410
(262) 250-7800
Mailing address
4425 N PORT WASHINGTON RD, ATTN: CSMCP CLINIC CREDENTIALING, GLENDALE, WI 53212-1082
(262) 250-7800
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
50349
WI
208000000X
Pediatrics Physician
50349
WI
Other
Enumeration date
11/20/2006
Last updated
06/12/2012
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