Healthcare Provider Details

I. General information

NPI: 1033832126
Provider Name (Legal Business Name): NATALIE MILES IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2022
Last Update Date: 09/22/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 WESTMOOR CT SW STE 100
OLYMPIA WA
98502-5754
US

IV. Provider business mailing address

7708 BRETHERTON AVE NE
LACEY WA
98516-6286
US

V. Phone/Fax

Practice location:
  • Phone: 360-227-1769
  • Fax:
Mailing address:
  • Phone: 802-503-7694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-136802
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: