Provider Demographics
NPI:1033586565
Name:STECKBAUER, KELLIE ANN (BSN, RN)
Entity type:Individual
Prefix:MS
First Name:KELLIE
Middle Name:ANN
Last Name:STECKBAUER
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2743 KEGONSA RD
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:WI
Mailing Address - Zip Code:53589-3354
Mailing Address - Country:US
Mailing Address - Phone:608-719-9214
Mailing Address - Fax:
Practice Address - Street 1:2743 KEGONSA RD
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:WI
Practice Address - Zip Code:53589-3354
Practice Address - Country:US
Practice Address - Phone:608-719-9214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-01
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI224896-30163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice