Healthcare Provider Details

I. General information

NPI: 1134723422
Provider Name (Legal Business Name): ANNE ELLE RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2020
Last Update Date: 11/26/2020
Certification Date: 11/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 YGNACIO VALLEY RD
WALNUT CREEK CA
94598-3194
US

IV. Provider business mailing address

1129 PALOMARES CT
LAFAYETTE CA
94549-3230
US

V. Phone/Fax

Practice location:
  • Phone: 925-947-5350
  • Fax:
Mailing address:
  • Phone: 925-698-2223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-162801
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: