Healthcare Provider Details

I. General information

NPI: 1306328778
Provider Name (Legal Business Name): MICHELE HOOPER RNC, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2018
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 JANES CIRCLE DR SW
ALEXANDRIA MN
56308-8870
US

IV. Provider business mailing address

730 JANES CIRCLE DR SW
ALEXANDRIA MN
56308-8870
US

V. Phone/Fax

Practice location:
  • Phone: 917-617-3546
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number51374
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: