Provider Demographics
NPI:1205184850
Name:TIBBS, DOREEN DENISE (IBCLC)
Entity Type:Individual
Prefix:
First Name:DOREEN
Middle Name:DENISE
Last Name:TIBBS
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:NGOZI
Other - Middle Name:DOREEN
Other - Last Name:TIBBS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:7761 PERSHING ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15235-1331
Mailing Address - Country:US
Mailing Address - Phone:412-638-1580
Mailing Address - Fax:
Practice Address - Street 1:7761 PERSHING ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15235-1331
Practice Address - Country:US
Practice Address - Phone:412-638-1580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN