Provider Demographics
NPI:1093459109
Name:STIBOREK, HAILEY KOCH (LM, CPM)
Entity Type:Individual
Prefix:
First Name:HAILEY
Middle Name:KOCH
Last Name:STIBOREK
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 HARBER AVE
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-6621
Mailing Address - Country:US
Mailing Address - Phone:972-816-3113
Mailing Address - Fax:
Practice Address - Street 1:409 W WALL ST
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-5203
Practice Address - Country:US
Practice Address - Phone:972-816-3113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99478176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty