Provider Demographics
NPI:1982009783
Name:GABLE, STEPHANIE (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:GABLE
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:962 TOMMY MUNRO DRIVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532
Mailing Address - Country:US
Mailing Address - Phone:228-363-0158
Mailing Address - Fax:
Practice Address - Street 1:962 TOMMY MUNRO DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532
Practice Address - Country:US
Practice Address - Phone:228-363-0158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSL-12748163WL0100X
MSR716642163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant