Healthcare Provider Details

I. General information

NPI: 1417371089
Provider Name (Legal Business Name): ELIZABETH SMITH RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELIZABETH BELTRAN-VAN SANT RN. IBCLC

II. Dates (important events)

Enumeration Date: 02/18/2014
Last Update Date: 02/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10202 RANCH RD
ROUGH AND READY CA
95975-9640
US

IV. Provider business mailing address

10202 RANCH RD
ROUGH AND READY CA
95975-9640
US

V. Phone/Fax

Practice location:
  • Phone: 530-713-3134
  • Fax:
Mailing address:
  • Phone: 530-713-3134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL13438
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: