Provider Demographics
NPI:1083319677
Name:SANCHEZ, STACY NICOLE (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:NICOLE
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8023 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-1236
Mailing Address - Country:US
Mailing Address - Phone:219-902-3547
Mailing Address - Fax:
Practice Address - Street 1:8023 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-1236
Practice Address - Country:US
Practice Address - Phone:219-902-3547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28194032C163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant