MEDICARE: STACY MCNALL APNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WA0400X	Addiction (Substance Use Disorder) Registered Nurse	139856	WI
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	9875-33	WI
3	163WP0808X	Psychiatric/Mental Health Registered Nurse	139856	WI

General Provider Information

NPI Number	:	1477199693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACY MCNALL APNP

Provider Business Mailing Address
First Line	:	25 KESSEL CT STE 105
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53711-6227
Country	:	US
Telephone Number	:	608-280-2700
Fax Number	:

Provider Business Practice Location Address
First Line	:	1433 N WATER ST STE 400-232
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-2557
Country	:	US
Telephone Number	:	415-735-5804
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2019
Last Update Date	:	11/08/2023

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