Healthcare Provider Details

I. General information

NPI: 1649059635
Provider Name (Legal Business Name): DEBRA KAY HERNLUND IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2023
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 MONTELAGO BLVD UNIT 431
HENDERSON NV
89011-3243
US

IV. Provider business mailing address

29 MONTELAGO BLVD UNIT 431
HENDERSON NV
89011-3243
US

V. Phone/Fax

Practice location:
  • Phone: 216-571-9997
  • Fax:
Mailing address:
  • Phone: 216-571-9997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-17222
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: