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General NPI Number Information
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NPI Number | 1942748637
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Entity Type | Individual
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Provider Name | ELIZABETH DECOU
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Gender | Female
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Dates
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Enumeration Date | 02/02/2017
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Last Update Date | 02/02/2017
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Provider Practice Location Address
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Address Line | 687 43RD ST
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City | OAKLAND
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State | CA
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Zip | 94609-1839
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Country | US
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Telephone | 503-502-1037
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Fax |
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Provider Business Mailing Address
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Address Line | 687 43RD ST
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City | OAKLAND
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State | CA
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Zip | 94609-1839
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Country | US
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Telephone | 503-502-1037
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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 | 163WL0100X
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Taxonomy Name | Lactation Consultant (Registered Nurse)
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License Number | 636090
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License Number State | CA
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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 | 198-14591
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License Number State | OR
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