Individual
STEPHANIE ROSE WYNN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
6811 118TH AVE, KENOSHA, WI 53142-8420
(262) 857-5750
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
9103
WI
363LF0000X
Family Nurse Practitioner
9103-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100097887
—
WI
Enumeration date
03/06/2019
Last updated
10/17/2024
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