Provider Demographics
NPI:1083948681
Name:HATTORI, STACY LYNN (CD (DONA))
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:LYNN
Last Name:HATTORI
Suffix:
Gender:F
Credentials:CD (DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 DAISYFIELD DR
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94551-3953
Mailing Address - Country:US
Mailing Address - Phone:925-413-6328
Mailing Address - Fax:
Practice Address - Street 1:178 DAISYFIELD DR
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94551-3953
Practice Address - Country:US
Practice Address - Phone:925-413-6328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADOULA CERT. DONA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula