Provider Demographics
NPI:1083311153
Name:CARLSEN, CHRISTINE (IBCLC)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:CARLSEN
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 1:144 SAVITZ RD
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:PA
Mailing Address - Zip Code:18444-7179
Mailing Address - Country:US
Mailing Address - Phone:570-561-5939
Mailing Address - Fax:
Practice Address - Street 1:144 SAVITZ RD
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:PA
Practice Address - Zip Code:18444-7179
Practice Address - Country:US
Practice Address - Phone:570-561-5939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAL-308562174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN