Stacy Lynn Wolf, BSN, RN, CDE

Primary specialty

Diabetes Educator Registered NurseTaxonomy code 163WD0400X

License

21420589 Issued in WI

Practice address

200 Woodland Prime
W126 N7338
Menomonee Falls, WI 53051

Phone

(414) 777-5998

NPI assigned

May 15, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor on Science - Nursing, Registered Nurse

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Froedtert & the Medical College of Wisconsin Community Physicians Inc.

  • Non-Pharmacy Dispensing Site
  • Wauwatosa, WI
  • NPI 1649626540
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1557878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557878400000",
    "number": "1043876048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 WOODLAND PRIME",
            "city": "MENOMONEE FALLS",
            "state": "WI",
            "postal_code": "530514476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 WOODLAND PRIME",
            "address_2": "W126 N7338",
            "city": "MENOMONEE FALLS",
            "state": "WI",
            "postal_code": "53051",
            "telephone_number": "414-777-5998"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 Woodland Prime",
            "address_2": "W126 N7338 Flint Drive",
            "address_purpose": "LOCATION",
            "city": "Menomonee Falls",
            "state": "WI",
            "postal_code": "53501",
            "country_code": "US",
            "telephone_number": "414-777-5998",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9200 W Wisconsin Ave",
            "address_purpose": "LOCATION",
            "city": "Milwaukee",
            "state": "WI",
            "postal_code": "532263522",
            "country_code": "US",
            "telephone_number": "414-777-5998",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WOLF",
        "first_name": "STACY",
        "middle_name": "LYNN",
        "credential": "BSN, RN, CDE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-15",
        "last_updated": "2019-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WD0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Diabetes Educator",
            "state": "WI",
            "license": "21420589",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FROEDTERT HEALTH",
            "identifier": "400106543",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wisconsin Dental Group, S.C.
• Wisconsin Vision, LLC
• Laura A Wittlin, MS, RD CD
• Brittany Marie Wohlfeil, FNP
• Sune Leif Wolf Pulsiano, MD
• Tyler Aaron Wolf
• Sung-Kyun Woo, M.D.
• Elizabeth Grace Woodman, MS, MFT-IT
• Michael Woyach, LCSW
• Aimee M Wozniak, PT

• Diabetes Educator Registered Nurse in Menomonee Falls, WI
• Providers in Menomonee Falls, WI by specialty
• Diabetes Educator Registered Nurse in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.