Provider Demographics
NPI:1295190031
Name:WESTON, DANA (RDH, IBCLC)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:WESTON
Suffix:
Gender:F
Credentials:RDH, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4665 COUGAR RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76126-5295
Mailing Address - Country:US
Mailing Address - Phone:817-980-6488
Mailing Address - Fax:
Practice Address - Street 1:4665 COUGAR RIDGE RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76126-5295
Practice Address - Country:US
Practice Address - Phone:817-980-6488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-21
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL-83686174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN