Most Relevant Information
Provider Data
| NPI Number: | 1003630914 |
| Provider Name: | STACY LEIGH LICHTIG NP |
| Entity Type: | Individual |
| Taxonomy Code: | 363LP2300X |
| Specialty: | Nurse Practitioner |
| License Number: | 15927-33 |
Most Important Dates
| Enumeration Date: | 11/08/2024 |
| Last Updated: | 11/08/2024 |
Provider Practice Location
N95W25901 COUNTY LINE RD STE F
COLGATE
WI
530179225
Practice Location Phone/Fax
| Phone: | 2626283727 |
| Fax: |
Provider Mailing Location
W197N12556 PRAIRIE RIDGE CT
RICHFIELD
WI
530769443
Provider Mailing Phone/Fax
| Phone: | 4145261338 |
| Fax: |