Acacia L Elmer, BSN, RNC-OB, IBCLC

Primary specialty

Lactation Consultant (Registered Nurse)Taxonomy code 163WL0100X

License

L-126781 Issued in WI

Practice address

277 N 9TH St
De Pere, WI 54115-1548

Phone

(920) 336-6594

NPI assigned

Jul 24, 2020

Reactivated

Nov 28, 2022

Last updated

Nov 30, 2022By 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

• Ms. Acacia Lauren Grube Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor on Science - Nursing

State licenses

Practice roles

Locations

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.

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  NPD Authorized official
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  dba De Pere Smiles S.C.

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  NPD
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  NPD (past)

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

{
    "created_epoch": "1595548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669766400000",
    "number": "1669081857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17718 MARQUETTE RD",
            "city": "REEDSVILLE",
            "state": "WI",
            "postal_code": "542309010",
            "telephone_number": "920-797-9055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "277 N 9TH ST",
            "city": "DE PERE",
            "state": "WI",
            "postal_code": "541151548",
            "telephone_number": "920-336-6594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELMER",
        "first_name": "ACACIA",
        "middle_name": "L",
        "name_prefix": "Mrs.",
        "credential": "BSN, RNC-OB, IBCLC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-24",
        "last_updated": "2022-11-30",
        "certification_date": "2022-11-30",
        "deactivation_date": "2021-09-03",
        "reactivation_date": "2022-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WL0100X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Lactation Consultant",
            "state": "WI",
            "license": "L-126781",
            "primary": true
        },
        {
            "code": "163WX0003X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Obstetric, Inpatient",
            "state": "WI",
            "license": "201504-30",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ACACIA",
            "last_name": "GRUBE",
            "middle_name": "LAUREN",
            "prefix": "MS.",
            "credential": "BSN, RN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Joshua Vincent Egle, PT, DPT
• Suzanne Eickert, APNP, DC
• Whitney Eidahl, MOTR/L
• Mark R Eklund, LCSW,MFT
• Rachael Marie Ellis, MD
• Employee Resource Center, Inc.
• Empower Play, LLC (Creative Wellness, LLC)
• Energize Health and Wellness
• Victoria Engels, LPC
• Heather Erfurt, MS, LAT, CES

• Lactation Consultant (Registered Nurse) in De Pere, WI
• Providers in De Pere, WI by specialty
• Lactation Consultant (Registered Nurse) in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2022; 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.