Provider Demographics
NPI:1538203179
Name:STIEMKE, MICHELE MARIE (LPN)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:MARIE
Last Name:STIEMKE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:MARIE
Other - Last Name:STIEMKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:300 GIBSON ST APT B
Mailing Address - Street 2:
Mailing Address - City:MUKWONAGO
Mailing Address - State:WI
Mailing Address - Zip Code:53149-1340
Mailing Address - Country:US
Mailing Address - Phone:262-305-2280
Mailing Address - Fax:
Practice Address - Street 1:300 GIBSON ST APT B
Practice Address - Street 2:
Practice Address - City:MUKWONAGO
Practice Address - State:WI
Practice Address - Zip Code:53149-1340
Practice Address - Country:US
Practice Address - Phone:262-305-2280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21730-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI21730-031OtherSTATE LICENSE