Provider Demographics
NPI:1376810283
Name:FENNER, CATHERINE MARY (IBCLC)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:MARY
Last Name:FENNER
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 1:526 NW 196TH PL
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98177-2544
Mailing Address - Country:US
Mailing Address - Phone:206-920-3084
Mailing Address - Fax:
Practice Address - Street 1:526 NW 196TH PL
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98177-2544
Practice Address - Country:US
Practice Address - Phone:206-920-3084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-20
Last Update Date:2011-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN