Healthcare Provider Details

I. General information

NPI: 1194321828
Provider Name (Legal Business Name): EMILY MERIDETH RN-C, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2020
Last Update Date: 12/08/2020
Certification Date: 12/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MOTHER-BABY UNIT 1601 YGNACIO VALLEY ROAD
WALNUT CREEK CA
94598
US

IV. Provider business mailing address

5544 LAWTON AVE
OAKLAND CA
94618-1509
US

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone: 510-333-4392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number556855
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-22704
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: