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General NPI Number Information
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NPI Number | 1033014436
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Entity Type | Individual
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Provider Name | STACI THERRIEN IBCLC
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Gender | Female
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Dates
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Enumeration Date | 10/14/2026
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Last Update Date | 10/14/2026
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Provider Practice Location Address
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Address Line | 522 POTTS ST
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City | DAVIDSON
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State | NC
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Zip | 28036-8406
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Country | US
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Telephone | 704-779-3173
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Fax |
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Provider Business Mailing Address
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Address Line | 7859 TRADEWINDS DR
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City | SHERRILLS FORD
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State | NC
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Zip | 28673-9273
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Country | US
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Telephone | 631-704-3654
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174N00000X
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Taxonomy Name | Lactation Consultant (Non-RN)
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License Number | L-323323
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License Number State | NC
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