Provider Demographics
NPI:1073942314
Name:STANDAGE, KARLA L (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:L
Last Name:STANDAGE
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 N 1100 E
Mailing Address - Street 2:LACTATION OFFICE
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2096
Mailing Address - Country:US
Mailing Address - Phone:801-855-3638
Mailing Address - Fax:801-855-3205
Practice Address - Street 1:170 N 1100 E
Practice Address - Street 2:LACTATION OFFICE
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2096
Practice Address - Country:US
Practice Address - Phone:801-855-3638
Practice Address - Fax:801-855-3205
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT212101-3102174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN