Provider Demographics
NPI:1669081857
Name:ELMER, ACACIA L (BSN, RNC-OB, IBCLC)
Entity type:Individual
Prefix:MRS
First Name:ACACIA
Middle Name:L
Last Name:ELMER
Suffix:
Gender:F
Credentials:BSN, RNC-OB, IBCLC
Other - Prefix:MS
Other - First Name:ACACIA
Other - Middle Name:LAUREN
Other - Last Name:GRUBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN, RN
Mailing Address - Street 1:17718 MARQUETTE RD
Mailing Address - Street 2:
Mailing Address - City:REEDSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54230-9010
Mailing Address - Country:US
Mailing Address - Phone:920-797-9055
Mailing Address - Fax:
Practice Address - Street 1:277 N 9TH ST
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-1548
Practice Address - Country:US
Practice Address - Phone:920-336-6594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-24
Last Update Date:2022-11-30
Deactivation Date:2021-09-03
Deactivation Code:
Reactivation Date:2022-11-28
Provider Licenses
StateLicense IDTaxonomies
WI201504-30163WX0003X
WIL-126781163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient