Individual
DR. STEPHANIE L BANTELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
610 W ADAMS ST, BLACK RIVER FALLS, WI 54615
(715) 284-4311
(715) 284-0475
Mailing address
610 W ADAMS ST, BLACK RIVER FALLS, WI 54615-9110
(715) 284-4311
(715) 284-0475
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
41109
IA
207Q00000X
Family Medicine Physician
Primary
57440-20
WI
390200000X
Student in an Organized Health Care Education/Training Program
3928-850
WI
390200000X
Student in an Organized Health Care Education/Training Program
57440-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3928-850
TEP
WI
01
—
41109
IOWA STATE BOARD
IA
01
—
57440-20
WI STATE LICENSE
WI
Enumeration date
10/25/2011
Last updated
06/30/2025
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