Provider Demographics
NPI:1750969432
Name:HIRSHMAN, STACEY M (FNLP, CFNC, CHHP)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:M
Last Name:HIRSHMAN
Suffix:
Gender:F
Credentials:FNLP, CFNC, CHHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 HEATHGATE LN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-2503
Mailing Address - Country:US
Mailing Address - Phone:919-602-6562
Mailing Address - Fax:
Practice Address - Street 1:4200 HEATHGATE LN
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-2503
Practice Address - Country:US
Practice Address - Phone:919-602-6562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education