Provider Demographics
NPI:1215015276
Name:SMITH, MADELINE J (RN, BSN, IBCLC)
Entity Type:Individual
Prefix:MS
First Name:MADELINE
Middle Name:J
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN, BSN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4914 44TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-2005
Mailing Address - Country:US
Mailing Address - Phone:206-722-8621
Mailing Address - Fax:
Practice Address - Street 1:4914 44TH AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-2005
Practice Address - Country:US
Practice Address - Phone:206-722-8621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00121956163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant