Active NPI
Stacy L Vandenput, CPM LICENSED MIDWIFE
- Midwife
- Green Bay, WI
National Provider Identifier
1316208044
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Midwife
- License
- 31-049
- Practice address
- 1638 Deckner Ave
Apartment One
Green Bay, WI 54302-2640 - Phone
- (920) 562-9058
- NPI assigned
- May 29, 2012
- Last updated
- Oct 12, 2016
- 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 6
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nutrition Education Nutritionist | 133NN1002X | NU | ||
| Midwife | 176B00000X | 31-049 | WI | Primary |
| Lactation Consultant (Non-RN) | 174N00000X | NU | ||
| Case Manager/Care Coordinator | 171M00000X | NU | ||
| Health Educator | 174H00000X | NU | ||
| Doula | 374J00000X | NU |
Addresses
Primary practice location
1638 Deckner Ave
Apartment One
Green Bay, WI 54302-2640
Mailing address
1638 Deckner Ave
Apartment One
Green Bay, WI 54302-2640
Phone (920) 562-9058
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 31-049 | WI | MD | Midwife |
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1338249600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1476230400000",
"number": "1316208044",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1638 DECKNER AVE",
"address_2": "APARTMENT ONE",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543022640",
"telephone_number": "920-562-9058"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1638 DECKNER AVE",
"address_2": "APARTMENT ONE",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543022640",
"telephone_number": "920-562-9058"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANDENPUT",
"first_name": "STACY",
"middle_name": "L",
"credential": "CPM LICENSED MIDWIFE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-05-29",
"last_updated": "2016-10-12",
"status": "A"
},
"taxonomies": [
{
"code": "133NN1002X",
"taxonomy_group": "",
"desc": "Nutritionist, Nutrition, Education",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "176B00000X",
"taxonomy_group": "",
"desc": "Midwife",
"state": "WI",
"license": "31-049",
"primary": true
},
{
"code": "174N00000X",
"taxonomy_group": "",
"desc": "Lactation Consultant, Non-RN",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "174H00000X",
"taxonomy_group": "",
"desc": "Health Educator",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "374J00000X",
"taxonomy_group": "",
"desc": "Doula",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Green Bay, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.