Provider Demographics
NPI:1154292415
Name:NAULT, STACEE RABER
Entity type:Individual
Prefix:
First Name:STACEE
Middle Name:RABER
Last Name:NAULT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 S SUNNYSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-4208
Mailing Address - Country:US
Mailing Address - Phone:206-235-3579
Mailing Address - Fax:
Practice Address - Street 1:619 S SUNNYSIDE AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-4208
Practice Address - Country:US
Practice Address - Phone:206-235-3579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-17
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist