Healthcare Provider Details

I. General information

NPI: 1518786847
Provider Name (Legal Business Name): CYNTHIA LEIGH GREEN RNC, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2024
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

642 ULUKAHIKI ST STE 305
KAILUA HI
96734-4439
US

IV. Provider business mailing address

1234 ALEXANDER ST APT 204
HONOLULU HI
96826-1231
US

V. Phone/Fax

Practice location:
  • Phone: 808-263-5433
  • Fax:
Mailing address:
  • Phone: 706-325-9418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number188233
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: