Individual
STACY L VANDENPUT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPM LICENSED MIDWIFE
Contact information
Practice address
1638 DECKNER AVE, APARTMENT ONE, GREEN BAY, WI 54302-2640
(920) 562-9058
Mailing address
1638 DECKNER AVE, APARTMENT ONE, GREEN BAY, WI 54302-2640
(920) 562-9058
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
—
—
171M00000X
Case Manager/Care Coordinator
—
—
174H00000X
Health Educator
—
—
174N00000X
Lactation Consultant (Non-RN)
—
—
176B00000X
Midwife
Primary
31-049
WI
374J00000X
Doula
—
—
Other
Enumeration date
05/29/2012
Last updated
10/12/2016
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