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General NPI Number Information
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NPI Number | 1043039605
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Entity Type | Individual
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Provider Name | KIMBERLY KOURETCHIAN RN, IBCLC
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Gender | Female
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Dates
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Enumeration Date | 10/09/2024
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 1621 W CARROLL AVE
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City | CHICAGO
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State | IL
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Zip | 60612-2501
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Country | US
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Telephone | 888-510-0059
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Fax | 708-406-1629
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Provider Business Mailing Address
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Address Line | 10185 MYSTIC FALLS DR
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City | LAS VEGAS
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State | NV
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Zip | 89141-9039
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Country | US
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Telephone | 206-708-3406
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN60593785
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 163WL0100X
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Taxonomy Name | Lactation Consultant (Registered Nurse)
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License Number | L-308290
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License Number State | WA
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