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General NPI Number Information
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NPI Number | 1649894379
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Entity Type | Individual
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Provider Name | RHEGAN RIANE DERFUS IBCLC
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Gender | Female
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Dates
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Enumeration Date | 05/28/2020
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Last Update Date | 05/28/2020
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Provider Practice Location Address
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Address Line | 3865 BARRACO DR
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City | SIERRA VISTA
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State | AZ
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Zip | 85650-4211
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Country | US
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Telephone | 520-508-0021
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Fax |
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Provider Business Mailing Address
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Address Line | 1846 E INNOVATION PARK DR STE 100
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City | ORO VALLEY
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State | AZ
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Zip | 85755-1963
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Country | US
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Telephone |
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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 | 174N00000X
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Taxonomy Name | Lactation Consultant (Non-RN)
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License Number | L-154093
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License Number State | AZ
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