Most Relevant Information
Provider Data
| NPI Number: | 1003183229 |
| Provider Name: | ELAINE RENEE ROSE IBCLC |
| Entity Type: | Individual |
| Taxonomy Code: | 174N00000X |
| Specialty: | Lactation Consultant, Non-RN |
| License Number: |
Most Important Dates
| Enumeration Date: | 11/17/2011 |
| Last Updated: | 11/17/2011 |
Provider Practice Location
12345 HEATHER ST NW
COON RAPIDS
MN
554331754
Practice Location Phone/Fax
| Phone: | 6129631301 |
| Fax: |
Provider Mailing Location
12345 HEATHER ST NW
COON RAPIDS
MN
554331754
Provider Mailing Phone/Fax
| Phone: | 6129631301 |
| Fax: |