Healthcare Provider Details

I. General information

NPI: 1619433224
Provider Name (Legal Business Name): DANICA JEAN ZAPATA STILES RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DANICA JEAN STILES RN, IBCLC

II. Dates (important events)

Enumeration Date: 02/19/2019
Last Update Date: 02/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1592 GROVE ST
EUGENE OR
97404-3901
US

IV. Provider business mailing address

1592 GROVE ST
EUGENE OR
97404-3901
US

V. Phone/Fax

Practice location:
  • Phone: 541-221-3388
  • Fax:
Mailing address:
  • Phone: 541-221-3388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-151868
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: