Provider Demographics
NPI:1336969195
Name:BEXTEL, STACEY (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:BEXTEL
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 1:813 TAMARAC DR
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-4425
Mailing Address - Country:US
Mailing Address - Phone:847-989-8990
Mailing Address - Fax:
Practice Address - Street 1:813 TAMARAC DR
Practice Address - Street 2:
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-4425
Practice Address - Country:US
Practice Address - Phone:847-989-8990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.341861163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant