Healthcare Provider Details

I. General information

NPI: 1922405943
Provider Name (Legal Business Name): CHRISTINE PRITCHARD R.N., IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2014
Last Update Date: 11/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

671 SIERRA STREET
MOSS BEACH CA
94038
US

IV. Provider business mailing address

PO BOX 155
MOSS BEACH CA
94038-0155
US

V. Phone/Fax

Practice location:
  • Phone: 650-728-3950
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number312489
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: