Provider Demographics
NPI:1134646771
Name:GOUDZWAARD, JULIANNE M (RN IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:JULIANNE
Middle Name:M
Last Name:GOUDZWAARD
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 1:841 BUCKBOARD DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451
Mailing Address - Country:US
Mailing Address - Phone:815-269-4344
Mailing Address - Fax:
Practice Address - Street 1:841 BUCKBOARD DRIVE
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451
Practice Address - Country:US
Practice Address - Phone:815-269-4344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041369052163WA2000X
ILL-82468163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant