IndividualActive
Michael Stark
NPI 1194617647 · Licensed Vocational Nurse · Pleasant Prairie, WI
Provider details
- NPI number
- 1194617647
- Entity type
- Individual
- Primary specialty
- Licensed Vocational NurseNursing Service Providers
- Sex
- Male
- Sole proprietor
- No
- License
- 719020 (CA)
Specialties & taxonomies
Nursing Service Providers
Nursing Service Providers
Practice location
12049 44th Ave
Pleasant Prairie, WI 53158-3927
Phone: (530) 562-5476
Approximate (ZIP-level) locationGet directions
Mailing address
12049 44th Ave
Pleasant Prairie, WI 53158-3927
Registry dates
- Enumerated
- 2025-07-18
- Last updated
- 2025-07-18
- Certified
- 2025-07-18
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.