Provider Demographics
NPI:1225338734
Name:HAFKEN, LYNNETTE ELLEN (IBCLC)
Entity Type:Individual
Prefix:
First Name:LYNNETTE
Middle Name:ELLEN
Last Name:HAFKEN
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 1:20701 SPINNING WHEEL PL
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-2814
Mailing Address - Country:US
Mailing Address - Phone:301-916-8482
Mailing Address - Fax:
Practice Address - Street 1:20701 SPINNING WHEEL PL
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-2814
Practice Address - Country:US
Practice Address - Phone:301-916-8482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-31
Last Update Date:2010-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist