Healthcare Provider Details

I. General information

NPI: 1407066459
Provider Name (Legal Business Name): ELIZABETH M SARGENT IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 11/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 WEBSTER ST
NEEDHAM MA
02494-2407
US

IV. Provider business mailing address

43 WEBSTER ST
NEEDHAM MA
02494-2407
US

V. Phone/Fax

Practice location:
  • Phone: 781-424-1127
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: