Provider Demographics
NPI:1316410129
Name:CONTI, CAROLYNN ELAINE (IBCLC, RN)
Entity Type:Individual
Prefix:
First Name:CAROLYNN
Middle Name:ELAINE
Last Name:CONTI
Suffix:
Gender:F
Credentials:IBCLC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4036 S 6TH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-4750
Mailing Address - Country:US
Mailing Address - Phone:208-573-1147
Mailing Address - Fax:
Practice Address - Street 1:4036 S 6TH ST
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-4750
Practice Address - Country:US
Practice Address - Phone:208-573-1147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-03
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201404525RN163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant