Provider Demographics
NPI:1134821325
Name:DALRYMPLE, STACY MARIE (CNM)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:MARIE
Last Name:DALRYMPLE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MRS
Other - First Name:STACY
Other - Middle Name:MARIE
Other - Last Name:DALRYMPLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNM
Mailing Address - Street 1:2670 FOXGLOVE DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49333-8085
Mailing Address - Country:US
Mailing Address - Phone:616-238-8989
Mailing Address - Fax:
Practice Address - Street 1:1535 GULL RD STE 250
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-1661
Practice Address - Country:US
Practice Address - Phone:269-226-5927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-20
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704330436367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty