Individual
LYNN M STANCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2323 S 102ND ST, WEST ALLIS, WI 53227-2103
(414) 541-9900
(414) 546-6790
Mailing address
4425 N PORT WASHINGTON RD, ATTN: CLINIC CREDENTIALING, GLENDALE, WI 53212-1082
(414) 541-9900
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
34575
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32038000
—
WI
Enumeration date
10/13/2006
Last updated
06/11/2012
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