Provider Demographics
NPI:1043686744
Name:WALKER, STACIE LEE (RN, APRN, IBCLC)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:LEE
Last Name:WALKER
Suffix:
Gender:F
Credentials:RN, APRN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 MARINE DR
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-3808
Mailing Address - Country:US
Mailing Address - Phone:503-468-0650
Mailing Address - Fax:844-905-1383
Practice Address - Street 1:1406 MARINE DR
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-3808
Practice Address - Country:US
Practice Address - Phone:503-468-0650
Practice Address - Fax:844-905-1383
Is Sole Proprietor?:No
Enumeration Date:2015-08-17
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60570432163W00000X
CORN.1643385163W00000X
OR201902371RN163WL0100X
COAPN.0992696-CNM367A00000X
WAAP60696754367A00000X
CA235949367A00000X
OR201902385NP-PP367A00000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant