Provider Demographics
NPI:1013599281
Name:ROBERTS, MICHELLE B (RN, IBCLC,RLC)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:B
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:RN, IBCLC,RLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 RUE DE LA PAIX
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-5303
Mailing Address - Country:US
Mailing Address - Phone:985-710-0438
Mailing Address - Fax:
Practice Address - Street 1:131 RUE DE LA PAIX
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-5303
Practice Address - Country:US
Practice Address - Phone:985-710-0438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA110694163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant