Healthcare Provider Details

I. General information

NPI: 1689942245
Provider Name (Legal Business Name): ADI KIRIATY IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2011
Last Update Date: 12/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20923 NE 44TH ST
SAMMAMISH WA
98074-9349
US

IV. Provider business mailing address

20923 NE 44TH ST
SAMMAMISH WA
98074-9349
US

V. Phone/Fax

Practice location:
  • Phone: 425-285-9590
  • Fax:
Mailing address:
  • Phone: 425-285-9590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number11169441
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: