Individual
MRS. STACY MARIE VANEGEREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
2961 SAINT ANTHONY DR, GREEN BAY, WI 54311-5860
(920) 468-0861
(920) 468-5869
Mailing address
2961 SAINT ANTHONY DR, GREEN BAY, WI 54311-5860
(920) 468-0861
(920) 468-5869
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1471-19
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1497025043
—
WI
Enumeration date
01/12/2012
Last updated
01/03/2013
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