Provider Demographics
NPI:1073897989
Name:AYRES, STACY A (NP)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:A
Last Name:AYRES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 COMMERCE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-8361
Mailing Address - Country:US
Mailing Address - Phone:715-377-9617
Mailing Address - Fax:
Practice Address - Street 1:625 COMMERCE DR STE 200
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-8361
Practice Address - Country:US
Practice Address - Phone:715-377-9617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-11
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4605363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner