Provider Demographics
NPI:1912350539
Name:STAPPAS, JESSICA L (APNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:STAPPAS
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:PEYTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APNP
Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:PO BOX 26099
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-7416
Mailing Address - Fax:
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-7416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7069-33363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1912350539Medicaid
WIK400319035Medicare PIN