Provider Demographics
NPI:1043994502
Name:GLOVER, STEPHANIE (LPN, IBCLC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:GLOVER
Suffix:
Gender:F
Credentials:LPN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 W K ST
Mailing Address - Street 2:
Mailing Address - City:ERWIN
Mailing Address - State:NC
Mailing Address - Zip Code:28339-1438
Mailing Address - Country:US
Mailing Address - Phone:910-658-8783
Mailing Address - Fax:
Practice Address - Street 1:104 TILGHMAN DR
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-5533
Practice Address - Country:US
Practice Address - Phone:910-892-1333
Practice Address - Fax:910-892-2929
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC70384164W00000X
L-310856174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No164W00000XNursing Service ProvidersLicensed Practical Nurse