Healthcare Provider Details

I. General information

NPI: 1467790964
Provider Name (Legal Business Name): VIOLET MARY DOYEN RNC, CLC, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2013
Last Update Date: 01/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2127 WATSON DR
JACKSON MO
63755-3286
US

IV. Provider business mailing address

2127 WATSON DR
JACKSON MO
63755-3286
US

V. Phone/Fax

Practice location:
  • Phone: 573-204-7373
  • Fax:
Mailing address:
  • Phone: 573-204-7373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number147400
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: