Healthcare Provider Details

I. General information

NPI: 1699968248
Provider Name (Legal Business Name): FREDERIKA ELLEN DROSTEN I.B.C.L.C, R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2007
Last Update Date: 08/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1048 MONTEREY AVENUE
BERKELEY CA
94707-2523
US

IV. Provider business mailing address

1048 MONTEREY AVE
BERKELEY CA
94707-2523
US

V. Phone/Fax

Practice location:
  • Phone: 510-524-4916
  • Fax:
Mailing address:
  • Phone: 510-524-4916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberU296776
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: