Individual
MRS. HEATHER L STACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
9200 W WISCONSIN AVE, MILWAUKEE, WI 53226-3522
(414) 955-1000
(414) 955-0183
Mailing address
9200 W WISCONSIN AVE, MILWAUKEE, WI 53226-3522
(414) 955-1000
(414) 955-0183
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
1541
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
008000261J
HUMANA
—
05
—
1841244993
—
WI
Enumeration date
05/22/2006
Last updated
10/06/2025
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