Healthcare Provider Details

I. General information

NPI: 1598496853
Provider Name (Legal Business Name): STACEY JANE SCHIEBEL APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. STACEY JANE LUCZAK

II. Dates (important events)

Enumeration Date: 06/17/2022
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 W WISCONSIN AVE
MILWAUKEE WI
53226-3522
US

IV. Provider business mailing address

9200 W WISCONSIN AVE
MILWAUKEE WI
53226-3522
US

V. Phone/Fax

Practice location:
  • Phone: 414-805-8700
  • Fax: 414-259-1522
Mailing address:
  • Phone: 414-805-8700
  • Fax: 414-259-1522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number13077
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number219802
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: