Healthcare Provider Details

I. General information

NPI: 1679357370
Provider Name (Legal Business Name): KRISTIN WEBER RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2023
Last Update Date: 08/23/2023
Certification Date: 08/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 E DUDLEY ST
MAUMEE OH
43537-3366
US

IV. Provider business mailing address

582 BECKLEE DR
NAPOLEON OH
43545-9129
US

V. Phone/Fax

Practice location:
  • Phone: 419-515-5375
  • Fax:
Mailing address:
  • Phone: 419-388-3479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRN.367346
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: