Provider Demographics
NPI:1003301839
Name:PANCIERA, JEANNE (RD, IBCLC)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:
Last Name:PANCIERA
Suffix:
Gender:F
Credentials:RD, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11182 MISTY WOODS LN NW
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312-4511
Mailing Address - Country:US
Mailing Address - Phone:360-473-6891
Mailing Address - Fax:
Practice Address - Street 1:11182 MISTY WOODS LN NW
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312-4511
Practice Address - Country:US
Practice Address - Phone:360-473-6891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA800460133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
17400000XOtherINTERNATIONAL BOARD OF LACTATION CONSULTANT EXAMENERS