Individual
STEPHANIE ELIZABETH BRUXVOORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
724 DENTON ST, LA CROSSE, WI 54601-5447
(608) 782-7300
Mailing address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
7913-23
WI
363AM0700X
Medical Physician Assistant
Primary
7913-23
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/20/2023
Last updated
09/10/2024
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