MEDICARE: STACY SPREWELL RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WA0400X	Addiction (Substance Use Disorder) Registered Nurse	167609	WI

General Provider Information

NPI Number	:	1942772827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACY SPREWELL RN

Provider Business Mailing Address
First Line	:	888 N EDGE TRL
Second Line	:
City	:	VERONA
State	:	WI
Zip	:	53593-1947
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	888 N EDGE TRL
Second Line	:
City	:	VERONA
State	:	WI
Zip	:	53593-1947
Country	:	US
Telephone Number	:	608-957-9483
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/17/2018
Last Update Date	:	12/17/2018

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