Provider Demographics
NPI:1396635199
Name:MCINTIRE, ERIN ELIZABETH MOFFETT (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:ELIZABETH MOFFETT
Last Name:MCINTIRE
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2883 HERMITAGE VIEW PL
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-4856
Mailing Address - Country:US
Mailing Address - Phone:719-360-7178
Mailing Address - Fax:
Practice Address - Street 1:2883 HERMITAGE VIEW PL
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-4856
Practice Address - Country:US
Practice Address - Phone:719-360-7178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-04
Last Update Date:2025-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL-63366163WL0100X
CA95317219163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant