Provider Demographics
NPI:1083949705
Name:MICHEL, DIANE S (MSPH, IBCLC, RLC)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:S
Last Name:MICHEL
Suffix:
Gender:F
Credentials:MSPH, IBCLC, RLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5233 LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-2847
Mailing Address - Country:US
Mailing Address - Phone:303-587-3326
Mailing Address - Fax:
Practice Address - Street 1:5233 LAUREL AVE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-2847
Practice Address - Country:US
Practice Address - Phone:303-587-3326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-14
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO108-66501174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN