Individual
MRS. ANTONETTE K STAHNKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2253 W MASON ST, GREEN BAY, WI 54303-4706
(920) 327-7300
(920) 327-7301
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(920) 327-7300
(920) 327-7301
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4940
WI
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100100258
—
WI
Enumeration date
07/09/2018
Last updated
04/19/2023
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