Healthcare Provider Details

I. General information

NPI: 1194130617
Provider Name (Legal Business Name): LORRAINE MARIE MILES RN, IBCLC-RLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LORRAINE MARIE HUGGINS

II. Dates (important events)

Enumeration Date: 06/23/2014
Last Update Date: 06/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20474 VARSITY DR
WALNUT CA
91789-1219
US

IV. Provider business mailing address

20474 VARSITY DR
WALNUT CA
91789-1219
US

V. Phone/Fax

Practice location:
  • Phone: 909-595-9620
  • Fax:
Mailing address:
  • Phone: 909-595-9620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN508531
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-33010
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: