Individual
STEPHANIE R SMULLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2845 GREENBRIER RD STE 240, GREEN BAY, WI 54311-6519
(920) 288-8280
(920) 288-8285
Mailing address
2845 GREENBRIER RD STE 240, PO BOX 8900, GREEN BAY, WI 54308-8900
(920) 288-8280
(920) 288-8285
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2242
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1316117500
—
MI
05
—
1316117500
—
WI
Enumeration date
03/04/2008
Last updated
08/02/2023
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