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NPI Code Detail

MEDICARE: DONNA LAREE VICKERS RN, IBCLC

MEDICARE: DONNA LAREE VICKERS RN, IBCLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WL0100XLactation Consultant (Registered Nurse)RN180365GA

General Provider Information

NPI Number : 1548021470
Entity Type Code : Individual
Provider Name (Legal Business Name) : DONNA LAREE VICKERS RN, IBCLC
Provider Business Mailing Address
First Line : 87 NOTTAWY BLVD
Second Line :
City : DOUGLAS
State : GA
Zip : 31535-4275
Country : US
Telephone Number : 912-381-5754
Fax Number :
Provider Business Practice Location Address
First Line : 1101 OCILLA RD
Second Line :
City : DOUGLAS
State : GA
Zip : 31533-2262
Country : US
Telephone Number : 912-384-1900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2024
Last Update Date : 01/18/2024

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