Healthcare Provider Details

I. General information

NPI: 1174816938
Provider Name (Legal Business Name): MARGARET ANNE EAUGALLIE R.N., I.B.C.L.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2011
Last Update Date: 05/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9027 ARGONNE WAY
FORESTVILLE CA
95436-9382
US

IV. Provider business mailing address

9027 ARGONNE WAY
FORESTVILLE CA
95436-9382
US

V. Phone/Fax

Practice location:
  • Phone: 707-887-7412
  • Fax:
Mailing address:
  • Phone: 707-887-7412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number370836
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: