Healthcare Provider Details

I. General information

NPI: 1689536005
Provider Name (Legal Business Name): JUSTINA MEYER IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2025
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3278 MILO ST NW
GRAND RAPIDS MI
49534-2471
US

IV. Provider business mailing address

3278 MILO ST NW
GRAND RAPIDS MI
49534-2471
US

V. Phone/Fax

Practice location:
  • Phone: 616-634-5629
  • Fax:
Mailing address:
  • Phone: 616-634-5629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL318964
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: