Provider Demographics
NPI:1407191778
Name:EASTBURN, JUDY (IBCLC)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:EASTBURN
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 1:730 BARTON SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75069-1985
Mailing Address - Country:US
Mailing Address - Phone:972-931-5578
Mailing Address - Fax:866-896-3834
Practice Address - Street 1:730 BARTON SPRINGS DR
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:TX
Practice Address - Zip Code:75069-1985
Practice Address - Country:US
Practice Address - Phone:972-931-5578
Practice Address - Fax:866-896-3834
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
18710195174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN