Provider Demographics
NPI:1316549769
Name:STOCKDALE, HOLLIE (RN, BSN, IBCLC)
Entity type:Individual
Prefix:
First Name:HOLLIE
Middle Name:
Last Name:STOCKDALE
Suffix:
Gender:F
Credentials:RN, BSN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 RIDGEOAK PL
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2303
Mailing Address - Country:US
Mailing Address - Phone:731-803-1313
Mailing Address - Fax:
Practice Address - Street 1:110 RIDGEOAK PL
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2303
Practice Address - Country:US
Practice Address - Phone:731-803-1313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-11
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN205419163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNL-315181OtherIBCLC