Staci J Boris, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

10173 Issued in WI

Practice address

2500 E Capitol Dr
Appleton, WI 54911-8735

Phone

(866) 455-8111

Fax

(920) 883-0491

NPI assigned

Jan 25, 2016

Last updated

Oct 12, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Staci J Doucette Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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

{
    "created_epoch": "1453680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602460800000",
    "number": "1386001154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 NEENAH CTR",
            "city": "NEENAH",
            "state": "WI",
            "postal_code": "549563070",
            "telephone_number": "920-454-4229",
            "fax_number": "920-993-5001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 E CAPITOL DR",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549118735",
            "telephone_number": "866-455-8111",
            "fax_number": "920-883-0491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BORIS",
        "first_name": "STACI",
        "middle_name": "J",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-01-25",
        "last_updated": "2020-10-12",
        "certification_date": "2020-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704210616",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WI",
            "license": "10173",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACI",
            "last_name": "DOUCETTE",
            "middle_name": "J",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Catherine Jean Borek, OT
• Clark Henry Boren Jr., MD
• Keily Leslie Borgelin, DDS
• Bradley James Borgen, APNP
• Kristin K Borgen, M.S., CCC-A
• Kaitlyn Bork
• Karen Borsheim, RPHH
• Nancy Elaine Bortolameolli
• Bortscreation LLC (Senior Helpers)
• Alice M Boshoven, MD

• Family Nurse Practitioner in Appleton, WI
• Providers in Appleton, WI by specialty
• Family Nurse Practitioner in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2020; 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.