Healthcare Provider Details

I. General information

NPI: 1215492327
Provider Name (Legal Business Name): CASEY ANN DEYOUNG RNC, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2019
Last Update Date: 02/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 WOLCOTT ST
MANCHESTER NH
03103-7370
US

IV. Provider business mailing address

109 WOLCOTT ST
MANCHESTER NH
03103-7370
US

V. Phone/Fax

Practice location:
  • Phone: 603-545-2714
  • Fax:
Mailing address:
  • Phone: 603-545-2714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number067884-21
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: