Provider Demographics
NPI:1487943361
Name:NOTESTINE, STACY LYNN (RN,IBCLC)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:LYNN
Last Name:NOTESTINE
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 1:11417 HUNTINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-9178
Mailing Address - Country:US
Mailing Address - Phone:740-438-2032
Mailing Address - Fax:614-829-6680
Practice Address - Street 1:11417 HUNTINGTON WAY
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-9178
Practice Address - Country:US
Practice Address - Phone:740-438-2032
Practice Address - Fax:614-829-6680
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN235410163WL0100X
OH10522085174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant