Healthcare Provider Details

I. General information

NPI: 1710147095
Provider Name (Legal Business Name): DANI JOELLE ATLAS LAVOIRE LM, CPM, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 01/19/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 E SHELDON ST
PRESCOTT AZ
86301-3119
US

IV. Provider business mailing address

1853 ROCKY RD
PRESCOTT AZ
86305-1332
US

V. Phone/Fax

Practice location:
  • Phone: 928-308-9656
  • Fax: 928-441-1980
Mailing address:
  • Phone: 928-308-9656
  • Fax: 928-441-1980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberLM0156
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: