Provider Demographics
NPI:1740811397
Name:SAFFERT, STACY R (APRN, CNP)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:R
Last Name:SAFFERT
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:R
Other - Last Name:WIEMERI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, CNP
Mailing Address - Street 1:200 1ST ST SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55905-0002
Mailing Address - Country:US
Mailing Address - Phone:715-838-5222
Mailing Address - Fax:
Practice Address - Street 1:1400 BELLINGER ST
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54703-5222
Practice Address - Country:US
Practice Address - Phone:715-838-5222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-03
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI136581363L00000X
WI9914363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner