Healthcare Provider Details

I. General information

NPI: 1376306704
Provider Name (Legal Business Name): MICHELE HEALOW RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2024
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 BOSWORTH ST UNIT A
SAN FRANCISCO CA
94112-1003
US

IV. Provider business mailing address

PO BOX 194
EL GRANADA CA
94018-0194
US

V. Phone/Fax

Practice location:
  • Phone: 415-509-4290
  • Fax:
Mailing address:
  • Phone: 415-509-4290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number839983
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: