Healthcare Provider Details

I. General information

NPI: 1790158871
Provider Name (Legal Business Name): JULIE ZUCK RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2015
Last Update Date: 11/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1029 FAIRHILL TER
SPRING VALLEY CA
91977-6540
US

IV. Provider business mailing address

1029 FAIRHILL TER
SPRING VALLEY CA
91977-6540
US

V. Phone/Fax

Practice location:
  • Phone: 360-643-3172
  • Fax:
Mailing address:
  • Phone: 360-643-3172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-84078
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: