Individual
STEPHANIE RENAE NOUROLLAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
10701 W RESEARCH DR, WAUWATOSA, WI 53226-3452
(866) 574-7135
Mailing address
4777 S US HIGHWAY 45, OSHKOSH, WI 54902-7465
Taxonomy
Speciality
Code
Description
License number
State
163WG0600X
Gerontology Registered Nurse
178574-30
WI
363LF0000X
Family Nurse Practitioner
Primary
8277-33
WI
Other
Enumeration date
02/07/2018
Last updated
03/12/2018
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