Provider Demographics
NPI:1922484955
Name:MEAD, STACI (CD(DONA))
Entity Type:Individual
Prefix:
First Name:STACI
Middle Name:
Last Name:MEAD
Suffix:
Gender:F
Credentials:CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3929 LYNNER DR
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50310-5838
Mailing Address - Country:US
Mailing Address - Phone:515-918-0125
Mailing Address - Fax:
Practice Address - Street 1:3929 LYNNER DR
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-5838
Practice Address - Country:US
Practice Address - Phone:515-918-0125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-31
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula