Healthcare Provider Details

I. General information

NPI: 1508572215
Provider Name (Legal Business Name): BARBARA C MAFNAS RN, MSN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2023
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

472 CHALAN SAN ANTONIO
TAMUNING GU
96913-3605
US

IV. Provider business mailing address

PO BOX 4388
YIGO GU
96929-4388
US

V. Phone/Fax

Practice location:
  • Phone: 671-777-6526
  • Fax:
Mailing address:
  • Phone: 671-777-6526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRX0241
License Number StateGU

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: