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NPI Code Detail

MEDICARE: MRS. DANETTE RACHELLE ANDERSEN IBCLC

MEDICARE: MRS. DANETTE RACHELLE ANDERSEN 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
1174N00000XLactation Consultant (Non-RN)10912881NC

General Provider Information

NPI Number : 1689012353
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DANETTE RACHELLE ANDERSEN IBCLC
Provider Business Mailing Address
First Line : 3614 COLE MILL RD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28270-1120
Country : US
Telephone Number : 704-608-8915
Fax Number :
Provider Business Practice Location Address
First Line : 6010 CARNEGIE BLVD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28209-4637
Country : US
Telephone Number : 704-384-9966
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/04/2013
Last Update Date : 07/13/2022

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