Individual
STACIE A EBBEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3925 N GATEWAY DR, APPLETON, WI 54913-7863
(920) 830-6877
Mailing address
N535 THELOSEN DR, APPLETON, WI 54915-5507
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
235881-30
WI
363L00000X
Nurse Practitioner
Primary
13149-33
WI
363LF0000X
Family Nurse Practitioner
13149
WI
Other
Enumeration date
09/07/2022
Last updated
10/13/2025
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