Provider Demographics
NPI:1487809943
Name:HITTMAN, STACEY J (APNP)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:J
Last Name:HITTMAN
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:M
Other - Last Name:HITTMAN, SCHMIDT-PRISTELSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APNP
Mailing Address - Street 1:1700 SAND ACRES DR STE 2A
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-7562
Mailing Address - Country:US
Mailing Address - Phone:920-819-2657
Mailing Address - Fax:
Practice Address - Street 1:1700 SAND ACRES DR STE 2A
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-7562
Practice Address - Country:US
Practice Address - Phone:920-373-8086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-25
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6235363LF0000X
WI3643-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI004920087Medicare Oscar/Certification
WI590050066Medicare Oscar/Certification