Healthcare Provider Details

I. General information

NPI: 1720169931
Provider Name (Legal Business Name): LEONA P. HALLOWS RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1997 MIAMISBURG-CENTERVILLE ROAD SOUTHVIEW HOSPITAL MATERNITY
DAYTON OH
45459
US

IV. Provider business mailing address

2918 CRONE RD
BEAVERCREEK OH
45434-6619
US

V. Phone/Fax

Practice location:
  • Phone: 937-401-6881
  • Fax: 937-401-7312
Mailing address:
  • Phone: 937-401-6881
  • Fax: 937-401-7312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number105-22301
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: