Active NPI
Stacy Lou Carlisle
- Registered Nurse
- Wayne, MI
National Provider Identifier
1417757485
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 4704260661
- Practice address
- 5049 Harrison St
Wayne, MI 48184-2220 - Phone
- (313) 971-2319
- NPI assigned
- Mar 18, 2025
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 4704260661 | MI | Primary |
Addresses
Primary practice location
5049 Harrison St
Wayne, MI 48184-2220
Mailing address
5049 Harrison St
Wayne, MI 48184-2220
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 |
|---|---|---|---|
| 4704260661 | MI | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1742256000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1742256000000",
"number": "1417757485",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5049 HARRISON ST",
"city": "WAYNE",
"state": "MI",
"postal_code": "481842220"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5049 HARRISON ST",
"city": "WAYNE",
"state": "MI",
"postal_code": "481842220",
"telephone_number": "313-971-2319"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARLISLE",
"first_name": "STACY",
"middle_name": "LOU",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-03-18",
"last_updated": "2025-03-18",
"certification_date": "2025-03-18",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "MI",
"license": "4704260661",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wayne, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.