Provider Demographics
NPI:1083907091
Name:ROBERTSON, CARLA BETH (IBCLC)
Entity Type:Individual
Prefix:MS
First Name:CARLA
Middle Name:BETH
Last Name:ROBERTSON
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 1:23919 LINDALE RANCH RD
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-9067
Mailing Address - Country:US
Mailing Address - Phone:918-413-3545
Mailing Address - Fax:
Practice Address - Street 1:23919 LINDALE RANCH RD
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-9067
Practice Address - Country:US
Practice Address - Phone:918-413-3545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11011770174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN