Healthcare Provider Details

I. General information

NPI: 1942535844
Provider Name (Legal Business Name): MARIE-CELINE FARVER RN BSN IBCLC RLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARIE-CELINE FARVER RN BSN IBCLC RLC

II. Dates (important events)

Enumeration Date: 10/09/2009
Last Update Date: 10/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 HUBBLE STREET
DAVIS CA
95616-2722
US

IV. Provider business mailing address

635 HUBBLE ST
DAVIS CA
95616-2722
US

V. Phone/Fax

Practice location:
  • Phone: 530-753-8319
  • Fax: 530-750-1444
Mailing address:
  • Phone: 530-753-8319
  • Fax: 530-750-1444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number106-22909
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: