Provider Demographics
NPI:1811378763
Name:SELTMANN, STACIE
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:
Last Name:SELTMANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STACIE
Other - Middle Name:
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92018-0247
Mailing Address - Country:US
Mailing Address - Phone:760-936-1261
Mailing Address - Fax:
Practice Address - Street 1:1411 VIA MARGUERITA
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-6972
Practice Address - Country:US
Practice Address - Phone:760-936-1261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-17
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula