Healthcare Provider Details

I. General information

NPI: 1043853856
Provider Name (Legal Business Name): STACY LOUISE HOBBS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2019
Last Update Date: 06/30/2024
Certification Date: 06/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3121 W SPENCER ST STE 170
APPLETON WI
54914-4323
US

IV. Provider business mailing address

1749 MARISSA CT
DE PERE WI
54115-7409
US

V. Phone/Fax

Practice location:
  • Phone: 920-940-8095
  • Fax:
Mailing address:
  • Phone: 920-396-9929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number245493-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: