Provider Demographics
NPI:1477201689
Name:CHAPIN, STACY (FDN-P)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:CHAPIN
Suffix:
Gender:F
Credentials:FDN-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11686 W CLEAR LAKE RD
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:WI
Mailing Address - Zip Code:54843-4063
Mailing Address - Country:US
Mailing Address - Phone:651-785-7377
Mailing Address - Fax:
Practice Address - Street 1:11686 W CLEAR LAKE RD
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:WI
Practice Address - Zip Code:54843-4063
Practice Address - Country:US
Practice Address - Phone:651-785-7377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No174H00000XOther Service ProvidersHealth Educator