Healthcare Provider Details

I. General information

NPI: 1992159883
Provider Name (Legal Business Name): CATHERINE KENDALL SANDS IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2016
Last Update Date: 04/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 N BAYLEN ST
PENSACOLA FL
32501-2118
US

IV. Provider business mailing address

1801 N BAYLEN ST
PENSACOLA FL
32501-2118
US

V. Phone/Fax

Practice location:
  • Phone: 850-454-8585
  • Fax:
Mailing address:
  • Phone: 850-454-8585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-17215
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: