Healthcare Provider Details

I. General information

NPI: 1669237699
Provider Name (Legal Business Name): CATHERINE OWLER IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2024
Last Update Date: 02/19/2024
Certification Date: 02/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3715 DAUPHIN ST STE 3B
MOBILE AL
36608-1764
US

IV. Provider business mailing address

9063 REDBERRY DR
MOBILE AL
36695-2417
US

V. Phone/Fax

Practice location:
  • Phone: 251-344-5900
  • Fax:
Mailing address:
  • Phone: 251-406-1954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number1-150328
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: