Individual
MRS. STACY A LEIDEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APNP
Contact information
Practice address
1102 S PARK ST, MADISON, WI 53715-1708
(608) 263-3111
(608) 263-6663
Mailing address
2901 W BELTLINE HWY, SUITE 120, MADISON, WI 53713-4226
(608) 443-5500
(608) 441-2385
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
226405-30
WI
363L00000X
Nurse Practitioner
Primary
6809-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1154415842
—
WI
01
—
11934107
CAQH
—
Enumeration date
10/03/2006
Last updated
02/03/2016
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