Provider Demographics
NPI:1386908366
Name:STAHL, KATHLEEN KENEALY (RN,IBCLC)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:KENEALY
Last Name:STAHL
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 1:1174 HAMPTON ROAD
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21409-4833
Mailing Address - Country:US
Mailing Address - Phone:443-458-8285
Mailing Address - Fax:
Practice Address - Street 1:1174 HAMPTON RD
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21409-4833
Practice Address - Country:US
Practice Address - Phone:443-458-8285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR161159163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant