Healthcare Provider Details

I. General information

NPI: 1801303631
Provider Name (Legal Business Name): JEANNIE CHOE LM, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2018
Last Update Date: 08/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 STANNAGE AVE
ALBANY CA
94706-2006
US

IV. Provider business mailing address

902 STANNAGE AVE
ALBANY CA
94706-2006
US

V. Phone/Fax

Practice location:
  • Phone: 917-825-6031
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-134970
License Number State
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberLM586
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: