Individual
STACI JO RADTKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APNP
Contact information
Practice address
1405 MILL ST, NEW LONDON, WI 54961-2155
(920) 531-2400
(920) 531-2466
Mailing address
3 NEENAH CTR, NEENAH, WI 54956-3070
(715) 526-7308
(715) 526-2111
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4264-33
WI
363LF0000X
Family Nurse Practitioner
4264
WI
Other
Enumeration date
11/11/2010
Last updated
11/27/2024
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