Individual
STEPHANIE DIANE CHUCKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
252 MCHENRY ST, BURLINGTON, WI 53105-1828
(262) 767-6000
Mailing address
W231N1440 CORPORATE CT STE 210, WAUKESHA, WI 53186-1303
(262) 896-6000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3876 - 23
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100061117
—
WI
Enumeration date
08/23/2016
Last updated
11/30/2021
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