Healthcare Provider Details

I. General information

NPI: 1093069619
Provider Name (Legal Business Name): HELENE R STACY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HELENE R SERWATKA

II. Dates (important events)

Enumeration Date: 11/05/2012
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 W WISCONSIN AVE
MILWAUKEE WI
53226-4874
US

IV. Provider business mailing address

9000 W WISCONSIN AVE
MILWAUKEE WI
53226-4874
US

V. Phone/Fax

Practice location:
  • Phone: 414-955-4170
  • Fax: 414-955-6543
Mailing address:
  • Phone: 414-955-4170
  • Fax: 414-955-6543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number209014748
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number5177
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: