Healthcare Provider Details

I. General information

NPI: 1881334506
Provider Name (Legal Business Name): KRISTEN GISH RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 03/30/2022
Certification Date: 03/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6697 RIDGE BLUFF DR
RURAL HALL NC
27045-9873
US

IV. Provider business mailing address

6697 RIDGE BLUFF DR
RURAL HALL NC
27045-9873
US

V. Phone/Fax

Practice location:
  • Phone: 302-354-8714
  • Fax:
Mailing address:
  • Phone: 302-354-8714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number310314
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number310314
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: