Healthcare Provider Details

I. General information

NPI: 1437069259
Provider Name (Legal Business Name): ALYSSA L CHANCE IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 CHANUTE RD
GOLDSBORO NC
27534-5515
US

IV. Provider business mailing address

307 CHANUTE RD
GOLDSBORO NC
27534-5515
US

V. Phone/Fax

Practice location:
  • Phone: 301-752-0711
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-322696
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: