Provider Demographics
NPI:1376897926
Name:STEVENS, SARAH RUSH (IBCLC)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:RUSH
Last Name:STEVENS
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 1:3730 RHONE CIR
Mailing Address - Street 2:STE 101
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5051
Mailing Address - Country:US
Mailing Address - Phone:907-561-5152
Mailing Address - Fax:907-562-2585
Practice Address - Street 1:3730 RHONE CIR
Practice Address - Street 2:STE 101
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5051
Practice Address - Country:US
Practice Address - Phone:907-561-5152
Practice Address - Fax:907-562-2585
Is Sole Proprietor?:No
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK10918138174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN