Provider Demographics
NPI:1285824995
Name:LERAGER, MICHELLE ANN
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:ANN
Last Name:LERAGER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:ANN
Other - Last Name:LERAGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN,IBCLC
Mailing Address - Street 1:1735 BLAKE ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94703-1901
Mailing Address - Country:US
Mailing Address - Phone:510-843-6497
Mailing Address - Fax:
Practice Address - Street 1:1735 BLAKE ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94703-1901
Practice Address - Country:US
Practice Address - Phone:510-843-6497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-29
Last Update Date:2007-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA258000163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant