Provider Demographics
NPI:1285178749
Name:CANNING, CAROLYN (IBCLC)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:CANNING
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:
Other - Last Name:CANNING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:911 N PASS AVE
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-2704
Mailing Address - Country:US
Mailing Address - Phone:818-486-1932
Mailing Address - Fax:
Practice Address - Street 1:911 N PASS AVE
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-2704
Practice Address - Country:US
Practice Address - Phone:818-486-1932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-16
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-109903174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN