Active NPI
Stacey L Andersen, LAC WI#803-55/ LMT W
- Acupuncturist
- Kenosha, WI
National Provider Identifier
1376970764
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acupuncturist
- License
- 803-55
- Practice address
- 5603 7TH Ave
Kenosha, WI 53140 - Phone
- (262) 496-5642
- NPI assigned
- Oct 1, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acupuncturist | 171100000X | 803-55 | WI | Primary |
| Massage Therapist | 225700000X | 4199-146 | WI |
Addresses
Primary practice location
5603 7TH Ave
Kenosha, WI 53140
Mailing address
8607 Old Green Bay Rd
Kenosha, WI 53158
Phone (262) 496-5642
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 |
|---|---|---|---|
| 803-55 | WI | MD | Acupuncturist |
| 4199-146 | WI | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1380585600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1380585600000",
"number": "1376970764",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8607 OLD GREEN BAY RD",
"city": "KENOSHA",
"state": "WI",
"postal_code": "53158",
"telephone_number": "262-496-5642"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5603 7TH AVE",
"city": "KENOSHA",
"state": "WI",
"postal_code": "53140",
"telephone_number": "262-496-5642"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSEN",
"first_name": "STACEY",
"middle_name": "L",
"name_prefix": "Ms.",
"credential": "LAC WI#803-55/ LMT W",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-10-01",
"last_updated": "2013-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "WI",
"license": "803-55",
"primary": true
},
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "WI",
"license": "4199-146",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kenosha, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.