Healthcare Provider Details

I. General information

NPI: 1457276271
Provider Name (Legal Business Name): ALEXANDRA MORALETA RN IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4402 E FLAMINGO AVE
NAMPA ID
83687-9203
US

IV. Provider business mailing address

4402 E FLAMINGO AVE
NAMPA ID
83687-9203
US

V. Phone/Fax

Practice location:
  • Phone: 208-205-0238
  • Fax: 208-205-0237
Mailing address:
  • Phone: 208-205-0238
  • Fax: 208-205-0237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number2761273
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: