Provider Demographics
NPI:1033857206
Name:HIGASHIBABA, ANJA (IBCLC)
Entity Type:Individual
Prefix:
First Name:ANJA
Middle Name:
Last Name:HIGASHIBABA
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 FURBER AVE UNIT 3
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-1707
Mailing Address - Country:US
Mailing Address - Phone:978-930-5484
Mailing Address - Fax:
Practice Address - Street 1:39 FURBER AVE UNIT 3
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-1707
Practice Address - Country:US
Practice Address - Phone:978-930-5484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAL-305952174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN