Healthcare Provider Details

I. General information

NPI: 1669299442
Provider Name (Legal Business Name): TERRA M ROHN IBCLC,CLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2024
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 NEW BRIDGE ST
JACKSONVILLE NC
28540-5435
US

IV. Provider business mailing address

6730 KALINOWSKI ST
TARAWA TERRACE NC
28543-1404
US

V. Phone/Fax

Practice location:
  • Phone: 910-333-6664
  • Fax:
Mailing address:
  • Phone: 603-717-2596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-313602
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: