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General NPI Number Information
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NPI Number | 1053886887
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Entity Type | Individual
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Provider Name | STACY PAULA CRUZ FNP-C
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Gender | Female
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Dates
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Enumeration Date | 10/08/2018
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Last Update Date | 02/28/2019
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Provider Practice Location Address
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Address Line | 949 N 9TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53233-1422
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Country | US
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Telephone | 414-226-7070
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Fax |
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Provider Business Mailing Address
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Address Line | 5207 S LAKE DR
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City | CUDAHY
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State | WI
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Zip | 53110-2013
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Country | US
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Telephone | 414-469-2559
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 8702-33
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License Number State | WI
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