Healthcare Provider Details

I. General information

NPI: 1255653531
Provider Name (Legal Business Name): DONNA LYNN GILBERT IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2010
Last Update Date: 01/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 TRAILS END CT
RALEIGH NC
27614-9618
US

IV. Provider business mailing address

128 TRAILS END CT
RALEIGH NC
27614-9618
US

V. Phone/Fax

Practice location:
  • Phone: 919-412-3471
  • Fax:
Mailing address:
  • Phone: 919-412-3471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number163WL0100X
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: