Healthcare Provider Details

I. General information

NPI: 1033463633
Provider Name (Legal Business Name): ELLEN HILARY SCHWERIN MPH, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2012
Last Update Date: 11/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2719 WOOLSEY ST
BERKELEY CA
94705-2606
US

IV. Provider business mailing address

2719 WOOLSEY ST
BERKELEY CA
94705-2606
US

V. Phone/Fax

Practice location:
  • Phone: 415-819-9769
  • Fax: 253-830-0722
Mailing address:
  • Phone: 415-819-9769
  • Fax: 253-830-0722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number11248161
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: