Provider Demographics
NPI:1306596333
Name:PAPPAS-HUDELSON, STEPHANIE (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:PAPPAS-HUDELSON
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 4TH ARTILLERY RD
Mailing Address - Street 2:
Mailing Address - City:FORT LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66027-1179
Mailing Address - Country:US
Mailing Address - Phone:917-408-3102
Mailing Address - Fax:
Practice Address - Street 1:811 4TH ARTILLERY RD
Practice Address - Street 2:
Practice Address - City:FORT LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66027
Practice Address - Country:US
Practice Address - Phone:917-408-3102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-24
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-161195-112163W00000X, 163WL0100X
NY831771163W00000X, 163WL0100X
KSL-314029163WL0100X
NYALPP-336782163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163W00000XNursing Service ProvidersRegistered Nurse