Healthcare Provider Details

I. General information

NPI: 1629689161
Provider Name (Legal Business Name): ALICE MARIA STEGMANN RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2020
Last Update Date: 08/10/2020
Certification Date: 08/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13355 N US HIGHWAY 183 APT 1611
AUSTIN TX
78750-7144
US

IV. Provider business mailing address

13355 N US HIGHWAY 183 APT 1611
AUSTIN TX
78750-7144
US

V. Phone/Fax

Practice location:
  • Phone: 269-312-0384
  • Fax:
Mailing address:
  • Phone: 269-312-0384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number953380
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: