Healthcare Provider Details

I. General information

NPI: 1881033785
Provider Name (Legal Business Name): SHIRLY MITTELMAN IBCLC, PCD(DONA)
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2013
Last Update Date: 06/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16530 NE 48TH ST
REDMOND WA
98052-5431
US

IV. Provider business mailing address

16530 NE 48TH ST
REDMOND WA
98052-5431
US

V. Phone/Fax

Practice location:
  • Phone: 425-442-7012
  • Fax:
Mailing address:
  • Phone: 425-442-7012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: