Provider Demographics
NPI:1235194747
Name:MLEKO, STACEY LEIGH (RN)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:LEIGH
Last Name:MLEKO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11720 SUMACH LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ARBOR VITAE
Mailing Address - State:WI
Mailing Address - Zip Code:54568-9141
Mailing Address - Country:US
Mailing Address - Phone:715-358-2399
Mailing Address - Fax:
Practice Address - Street 1:11720 SUMACH LAKE RD
Practice Address - Street 2:
Practice Address - City:ARBOR VITAE
Practice Address - State:WI
Practice Address - Zip Code:54568-9141
Practice Address - Country:US
Practice Address - Phone:715-358-2399
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38354600Medicaid