Healthcare Provider Details

I. General information

NPI: 1487315453
Provider Name (Legal Business Name): ALLISON ELIZABETH SMIGIEL RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2022
Last Update Date: 01/03/2022
Certification Date: 12/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VIRTUAL HOME OFFICE
VESTAL NY
13850
US

IV. Provider business mailing address

340 BIRCH ST
VESTAL NY
13850-1902
US

V. Phone/Fax

Practice location:
  • Phone: 607-258-5616
  • Fax:
Mailing address:
  • Phone: 607-592-6357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number616349-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163WP1700X
TaxonomyPerinatal Registered Nurse
License Number616349-01
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: