Provider Demographics
NPI:1235437476
Name:HAMRE, STACEY LEE (RN)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:LEE
Last Name:HAMRE
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 1:119 MERTON AVE
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:WI
Mailing Address - Zip Code:53555-1424
Mailing Address - Country:US
Mailing Address - Phone:608-592-0155
Mailing Address - Fax:
Practice Address - Street 1:119 MERTON AVE
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:WI
Practice Address - Zip Code:53555-1424
Practice Address - Country:US
Practice Address - Phone:608-592-0155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-12
Last Update Date:2011-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI120989-030163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health