Provider Demographics
NPI:1699409268
Name:GALLMAN, STACI (RN, BSN, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:STACI
Middle Name:
Last Name:GALLMAN
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 1:114 WYNBROOK WAY
Mailing Address - Street 2:
Mailing Address - City:BOILING SPRINGS
Mailing Address - State:SC
Mailing Address - Zip Code:29316-5163
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:114 WYNBROOK WAY
Practice Address - Street 2:
Practice Address - City:BOILING SPRINGS
Practice Address - State:SC
Practice Address - Zip Code:29316-5163
Practice Address - Country:US
Practice Address - Phone:864-491-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCL-307741163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCL-307741OtherINTERNATIONAL BOARD OF LACTATION CONSULTANT EXAMINERS