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General NPI Number Information
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NPI Number | 1336947530
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Entity Type | Individual
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Provider Name | STACIE R MITCHELL DOULA
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Gender | Female
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Dates
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Enumeration Date | 03/04/2025
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Last Update Date | 03/04/2025
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Provider Practice Location Address
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Address Line | 900 E 162ND ST
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City | SOUTH HOLLAND
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State | IL
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Zip | 60473-2471
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Country | US
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Telephone | 708-331-8111
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Fax | 708-331-8088
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Provider Business Mailing Address
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Address Line | 4707 PERSHING BLVD
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City | KENOSHA
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State | WI
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Zip | 53144-3505
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Country | US
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Telephone | 262-620-1470
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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 | 374J00000X
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Taxonomy Name | Doula
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License Number |
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License Number State |
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