Basic Information
| Provider Information | |||||||||
| NPI: | 1902372444 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRANDT | ||||||||
| FirstName: | STACEY | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1061 E COMMERCE BLVD | ||||||||
| Address2: | |||||||||
| City: | SLINGER | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530869326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2626442900 | ||||||||
| FaxNumber: | 2626442977 | ||||||||
| Practice Location | |||||||||
| Address1: | 1061 E COMMERCE BLVD | ||||||||
| Address2: | |||||||||
| City: | SLINGER | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530869326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2626442900 | ||||||||
| FaxNumber: | 2626442977 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2018 | ||||||||
| LastUpdateDate: | 11/24/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 8767-033 | WI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.