Healthcare Provider Details

I. General information

NPI: 1053663054
Provider Name (Legal Business Name): LOIS KARLEEN ACOSTA IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LOIS KARLEEN KARR

II. Dates (important events)

Enumeration Date: 10/15/2012
Last Update Date: 10/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 COMMERCE DR
PRESCOTT AZ
86305-3700
US

IV. Provider business mailing address

1090 COMMERCE DR
PRESCOTT AZ
86305-3700
US

V. Phone/Fax

Practice location:
  • Phone: 928-442-5562
  • Fax: 928-771-3369
Mailing address:
  • Phone: 928-771-3121
  • Fax: 928-771-3369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: