Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Stacey Wallace, RN

Individual provider Addiction (Substance Use Disorder) Registered Nurse · NPI 1053136317

Stacey Wallace, RN is an Addiction (Substance Use Disorder) Registered Nurse in Kenosha, Wisconsin. Licensed in Wisconsin. Registered with an NPI since 2024.

Licensed in
WI
In the registry since
2024
What do these letters mean?
RN — Registered Nurse
A licensed nurse who completed a nursing degree and passed the NCLEX-RN examination.

See every abbreviation used in this directory →

Practice location Address checks out

3825 39th Ave Ste 120
Kenosha, WI 53144-2043
Phone: (262) 946-5752
Fax: (262) 946-5765
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Addiction (Substance Use Disorder) Registered Nurse (primary) Taxonomy 163WA0400X · Licence 251425-30 (WI)

Record details

NPI number1053136317
Entity typeIndividual (Type 1)
GenderFemale
Credentials RN
Sole proprietorNo
NPI enumeratedNovember 20, 2024
Last updated in NPPESNovember 20, 2024
Certification dateNovember 20, 2024
Mailing address3825 39th Ave Ste 120, Kenosha, WI 53144-2043

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