Healthcare Provider Details

I. General information

NPI: 1750527594
Provider Name (Legal Business Name): GWENDOLYN R. WEST IBCLC, RLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GWENDOLYN R WEST IBCLC

II. Dates (important events)

Enumeration Date: 12/29/2008
Last Update Date: 05/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 U ST NW
WASHINGTON DC
20001-2338
US

IV. Provider business mailing address

509 U ST NW
WASHINGTON DC
20001-2338
US

V. Phone/Fax

Practice location:
  • Phone: 202-378-7536
  • Fax:
Mailing address:
  • Phone: 202-378-7536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number191-10809
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number191-10809
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number191-10809
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: