Provider Demographics
NPI:1639326143
Name:SPAHN, STACEY LEA (APNP, FNP-C)
Entity type:Individual
Prefix:MS
First Name:STACEY
Middle Name:LEA
Last Name:SPAHN
Suffix:
Gender:F
Credentials:APNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7795 LAKE THOMAS RD
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54482-9744
Mailing Address - Country:US
Mailing Address - Phone:715-347-5654
Mailing Address - Fax:833-471-4700
Practice Address - Street 1:460 N BIRON DR
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494-1843
Practice Address - Country:US
Practice Address - Phone:715-507-6118
Practice Address - Fax:833-471-4700
Is Sole Proprietor?:No
Enumeration Date:2008-08-27
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI128550-030163W00000X
NV852688363LF0000X
WI14197-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35061700Medicaid