Provider Demographics
NPI:1750332599
Name:LERRET, STACEE M (APNP)
Entity Type:Individual
Prefix:MS
First Name:STACEE
Middle Name:M
Last Name:LERRET
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:PEDIATRIC GASTROENTEROLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-266-3944
Mailing Address - Fax:414-266-3676
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:PEDIATRIC GASTROENTEROLOGY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4874
Practice Address - Country:US
Practice Address - Phone:414-266-3944
Practice Address - Fax:414-266-3676
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI2331363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1750332599Medicaid
WI1750332599Medicaid
WI736012123Medicare PIN
WI680860878Medicare PIN