Healthcare Provider Details

I. General information

NPI: 1861600082
Provider Name (Legal Business Name): JULIA DENNISTON RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4165 BLACKHAWK PLAZA CIR
DANVILLE CA
94506-4904
US

IV. Provider business mailing address

51 STONECASTLE CT
ALAMO CA
94507-1178
US

V. Phone/Fax

Practice location:
  • Phone: 925-683-1933
  • Fax: 925-935-8491
Mailing address:
  • Phone: 925-683-1933
  • Fax: 925-935-8491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number392957
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: