Provider Demographics
NPI:1619183217
Name:MOORE, STEPHANIE ELIZABETH ALTON (RN, BSN, IBCLC)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:ELIZABETH ALTON
Last Name:MOORE
Suffix:
Gender:F
Credentials:RN, BSN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 ARAPAHOE AVE
Mailing Address - Street 2:H-12B
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-6720
Mailing Address - Country:US
Mailing Address - Phone:303-546-6262
Mailing Address - Fax:303-546-6263
Practice Address - Street 1:2525 ARAPAHOE AVE
Practice Address - Street 2:H-12B
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-6720
Practice Address - Country:US
Practice Address - Phone:303-546-6262
Practice Address - Fax:303-546-6263
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO196-13456163WL0100X
CO111029163WP1700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163WP1700XNursing Service ProvidersRegistered NursePerinatal