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Individual

MS. DANA MARY STOUT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
APNP

Contact information

Practice address
7401 104TH AVENUE, SUITE 110, COMPREHENSIVE ORTHOPAEDICS, S.C., KENOSHA, WI 53142
(414) 325-7246
(414) 325-3770
Mailing address
7401 104TH AVE STE 110, COMPREHENSIVE ORTHOPAEDICS, S.C., KENOSHA, WI 53142-7845
(262) 764-5595
(262) 764-9314

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
158976
WI
363L00000X
Nurse Practitioner
Primary
6479-33
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
13577846
CAQH
Enumeration date
06/22/2015
Last updated
12/03/2015
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