Individual
STACEY LEE BISENIUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.D.H.
Contact information
Practice address
15397 STATE HWY 32, LAKEWOOD, WI 54138
(715) 276-6321
Mailing address
PO BOX 179, LAKEWOOD, WI 54138-0179
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
6563016
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33805900
—
WI
Enumeration date
12/21/2006
Last updated
07/08/2007
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