Healthcare Provider Details

I. General information

NPI: 1851179162
Provider Name (Legal Business Name): ABBIE FICSOR IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2023
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4451 S AMMONS ST UNIT 2-303
DENVER CO
80123-5452
US

IV. Provider business mailing address

4451 S AMMONS ST UNIT 2-303
DENVER CO
80123-5452
US

V. Phone/Fax

Practice location:
  • Phone: 720-425-8574
  • Fax:
Mailing address:
  • Phone: 720-425-8574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-310972
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: