Healthcare Provider Details

I. General information

NPI: 1881364834
Provider Name (Legal Business Name): ANNMARIE HEXT RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2021
Last Update Date: 09/20/2021
Certification Date: 09/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5880 MOUNTAIN HAWK DR
SANTA ROSA CA
95409-4356
US

IV. Provider business mailing address

5880 MOUNTAIN HAWK DR
SANTA ROSA CA
95409-4356
US

V. Phone/Fax

Practice location:
  • Phone: 310-502-0886
  • Fax:
Mailing address:
  • Phone: 310-502-0886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number666098
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: