Active NPI
Stacy Leigh Lichtig, NP
- Primary Care Nurse Practitioner
- Colgate, WI
National Provider Identifier
1003630914
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Primary Care Nurse Practitioner
- License
- 15927-33
- Practice address
- N95W25901 County Line Rd Ste F
Colgate, WI 53017-9225 - Phone
- (262) 628-3727
- NPI assigned
- Nov 8, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Nurse Practitioner | 363LP2300X | 15927-33 | WI | Primary |
Addresses
Primary practice location
N95W25901 County Line Rd Ste F
Colgate, WI 53017-9225
Mailing address
W197N12556 Prairie Ridge CT
Richfield, WI 53076-9443
Phone (414) 526-1338
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15927-33 | WI | MD | Primary Care Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1731024000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1731024000000",
"number": "1003630914",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "W197N12556 PRAIRIE RIDGE CT",
"city": "RICHFIELD",
"state": "WI",
"postal_code": "530769443",
"telephone_number": "414-526-1338"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "N95W25901 COUNTY LINE RD STE F",
"city": "COLGATE",
"state": "WI",
"postal_code": "530179225",
"telephone_number": "262-628-3727"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LICHTIG",
"first_name": "STACY",
"middle_name": "LEIGH",
"credential": "NP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-11-08",
"last_updated": "2024-11-08",
"certification_date": "2024-11-08",
"status": "A"
},
"taxonomies": [
{
"code": "363LP2300X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Primary Care",
"state": "WI",
"license": "15927-33",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Colgate, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.