Organization
STELLAR CARE LLC
Active
Other names
Stellar Care
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SHANNA MARIE JOHNSON NP (PRESIDENT)
(414) 573-0179
Entity
Organization
Contact information
Practice address
10625 W NORTH AVE STE 230, MILWAUKEE, WI 53226-2315
(414) 249-5698
(320) 207-5719
Mailing address
10625 W NORTH AVE STE 230, WAUWATOSA, WI 53226-2315
(414) 249-5698
(320) 207-5719
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1386940575
—
WI
Enumeration date
06/04/2021
Last updated
05/30/2024
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