Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 174N00000X | Lactation Consultant |
NPI | 1366949612 |
---|---|
Provider Name | Staci Campbell |
First Address | Statesville, NC 28625-6402 |
Second Address | Mooresville, NC 28115-2811 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2018 |
Last Update Date | 11/11/2021 |