Brenda Stallbaum, APNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

7373-33 Issued in WI

Practice address

339 Reed Ave
Manitowoc, WI 54220-2020

Phone

(920) 320-8600

NPI assigned

Jan 19, 2017

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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.

• Mathew McCarthy, MD, SC

  • Adult Mental Health Clinic/Center
  • Kenosha, WI
  • NPI 1326179987
  NPD (past)

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

{
    "created_epoch": "1484784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561075200000",
    "number": "1124565882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2290",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542212290",
            "telephone_number": "920-320-2591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "339 REED AVE",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542202020",
            "telephone_number": "920-320-8600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STALLBAUM",
        "first_name": "BRENDA",
        "credential": "APNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-01-19",
        "last_updated": "2019-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WI",
            "license": "7373-33",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sheridan M Specht, NP
• Basil P Spyropoulos, M.D.
• Punya Srikanth, DMD
• St. Mary'S Home for the Aged, Inc
• Debra Ann St.Pierre, RPH
• Diane L Staudinger, MD
• Megan Danielle Stein, COTA
• John M Stern, M.D.
• Steven M. Amato, D.D.S., M.S., S.C.
• Shari Lee Stevens, RN

• Psychiatric/Mental Health Nurse Practitioner in Manitowoc, WI
• Providers in Manitowoc, WI by specialty
• Psychiatric/Mental Health Nurse Practitioner in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 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.