Healthcare Provider Details

I. General information

NPI: 1770877599
Provider Name (Legal Business Name): MELISSA FOSTER LONNERGAN RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2011
Last Update Date: 06/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1874 BELTLINE RD SW
DECATUR AL
35601-5514
US

IV. Provider business mailing address

51 WALTER LN
DECATUR AL
35603-5426
US

V. Phone/Fax

Practice location:
  • Phone: 256-301-3393
  • Fax: 256-301-3487
Mailing address:
  • Phone: 256-301-3393
  • Fax: 256-301-3487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number10016630
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: