Healthcare Provider Details

I. General information

NPI: 1801428503
Provider Name (Legal Business Name): SARA WHITEHOUSE RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2020
Last Update Date: 02/10/2020
Certification Date: 02/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 RAMONA WAY
OCEANSIDE CA
92057-7377
US

IV. Provider business mailing address

153 RAMONA WAY
OCEANSIDE CA
92057-7377
US

V. Phone/Fax

Practice location:
  • Phone: 229-292-9119
  • Fax:
Mailing address:
  • Phone: 229-292-9119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRN95134261
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: