Provider Demographics
NPI:1891550844
Name:DAUM, STEPHANIE JOYCE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JOYCE
Last Name:DAUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:JOYCE
Other - Last Name:WOKRAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2007 SAN ANTONIO CT
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-3168
Mailing Address - Country:US
Mailing Address - Phone:805-757-4256
Mailing Address - Fax:
Practice Address - Street 1:2007 SAN ANTONIO CT
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-3168
Practice Address - Country:US
Practice Address - Phone:805-757-4256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL-314688174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN