NPIMap

Individual provider Active NPI

Stacy Mielke, FNP-BC

  • Family Nurse Practitioner
  • Appleton, WI
National Provider Identifier
1255037305
Registry record updated Feb 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
13598-33 Issued in WI
Practice address
2500 E Capitol Dr # 2600
Appleton, WI 54911-8735
Phone
(920) 734-9600
NPI assigned
Jan 31, 2023
Last updated
Feb 13, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 13598-33 WI Primary

Addresses

Primary practice location

2500 E Capitol Dr # 2600
Appleton, WI 54911-8735

Mailing address

1012 Tana LN
Menasha, WI 54952-2964
Phone (920) 979-1226

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230328000857 WI Practitioner - Nurse Practitioner 9133593080 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fox Valley Pulmonary Medicine SCGroup PAC ID 6002707320, 12 clinicians

Practice addresses (Care Compare)

130 2ND St
Neenah, WI 54956-2883
Phone (920) 358-1139

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Fox Valley Pulmonary Medicine, S.C. CurrentSince Feb 20, 2023 Accepting new patients

Locations

2500 E Capitol Dr
Ste 2600
Appleton, WI 54911
Phone (920) 358-1139

130 2nd St
Neenah, WI 54956
Phone (920) 729-2063

200 Theda Clark Medical Plz
Ste 480
Neenah, WI 54956
Phone (920) 729-0608

Organizations & group practices 1

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

Hospital & facility affiliations 12

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1675123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676246400000",
    "number": "1255037305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1012 TANA LN",
            "city": "MENASHA",
            "state": "WI",
            "postal_code": "549522964",
            "telephone_number": "920-979-1226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 E CAPITOL DR # 2600",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549118735",
            "telephone_number": "920-734-9600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIELKE",
        "first_name": "STACY",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-01-31",
        "last_updated": "2023-02-13",
        "certification_date": "2023-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WI",
            "license": "13598-33",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Appleton, WI

Sources for this page

Verify at the official NPI Registry.