Healthcare Provider Details

I. General information

NPI: 1154719433
Provider Name (Legal Business Name): SHANNON COLLEEN HUFFMAN BA, CLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2015
Last Update Date: 01/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 W WEBB AVE
BURLINGTON NC
27217-3706
US

IV. Provider business mailing address

530 W WEBB AVE
BURLINGTON NC
27217-3706
US

V. Phone/Fax

Practice location:
  • Phone: 336-228-8316
  • Fax: 336-227-9750
Mailing address:
  • Phone: 336-228-8316
  • Fax: 336-227-9750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberALPP-208663
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: