Individual
SALLY A STAE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
21400 LANCELOT DR, BROOKFIELD, WI 53045-1633
(262) 349-0867
Mailing address
713 STATE ST, OCONOMOWOC, WI 53066-3744
(262) 434-0969
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
85462
WI
Other
Enumeration date
06/27/2018
Last updated
06/27/2018
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