Provider Demographics
NPI:1053663054
Name:ACOSTA, LOIS KARLEEN (IBCLC)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:KARLEEN
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:LOIS
Other - Middle Name:KARLEEN
Other - Last Name:KARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1090 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-3700
Mailing Address - Country:US
Mailing Address - Phone:928-771-3121
Mailing Address - Fax:928-771-3369
Practice Address - Street 1:1090 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-3700
Practice Address - Country:US
Practice Address - Phone:928-442-5562
Practice Address - Fax:928-771-3369
Is Sole Proprietor?:No
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ11193258OtherIBCLC