Healthcare Provider Details

I. General information

NPI: 1316699044
Provider Name (Legal Business Name): KRISTIN ANN CONLEY IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2022
Last Update Date: 01/24/2022
Certification Date: 01/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2902 ZUNI ST
DENVER CO
80211-3827
US

IV. Provider business mailing address

2340 HARMONY PARK DR
WESTMINSTER CO
80234-2773
US

V. Phone/Fax

Practice location:
  • Phone: 303-250-0534
  • Fax:
Mailing address:
  • Phone: 303-250-0534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-104791
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: