Healthcare Provider Details

I. General information

NPI: 1700830288
Provider Name (Legal Business Name): STACY CESARIO RN, APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 OVERLOOK TER
MADISON WI
53705-2254
US

IV. Provider business mailing address

523 RIVERSIDE DR
DE FOREST WI
53532-3217
US

V. Phone/Fax

Practice location:
  • Phone: 608-280-7002
  • Fax: 608-280-7290
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number85048-030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: