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NPI Code Detail

MEDICARE: ELIZABETH ELLEN WATERS IBCLC, RLC, CPPD

MEDICARE: ELIZABETH ELLEN WATERS IBCLC, RLC, CPPD
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)LC-10196698OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1LC-LC-10196698OTHEROROREGON HEALTH LICENSING-LACTATION CONSULTANT PROGRAM
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3L-152153OTHERVAINTERNATIONAL BOARD OF LACTATION CONSULTANT EXAMINERS

General Provider Information

NPI Number : 1932663309
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH ELLEN WATERS IBCLC, RLC, CPPD
Provider Business Mailing Address
First Line : 462 SW VALERIA VIEW DR APT 303
Second Line :
City : PORTLAND
State : OR
Zip : 97225-7085
Country : US
Telephone Number : 503-755-8328
Fax Number : 503-506-0676
Provider Business Practice Location Address
First Line : 3323 SW NAITO PKWY
Second Line :
City : PORTLAND
State : OR
Zip : 97239-4672
Country : US
Telephone Number : 503-755-8328
Fax Number : 503-506-0676
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/29/2019
Last Update Date : 06/06/2024

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