Provider Demographics
NPI:1407310188
Name:DE VARONA, MISTEL (IBCLC)
Entity Type:Individual
Prefix:
First Name:MISTEL
Middle Name:
Last Name:DE VARONA
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 1:29108 MISTY PINES ST
Mailing Address - Street 2:
Mailing Address - City:DOWAGIAC
Mailing Address - State:MI
Mailing Address - Zip Code:49047-7751
Mailing Address - Country:US
Mailing Address - Phone:269-783-6225
Mailing Address - Fax:
Practice Address - Street 1:2149 E NAPIER AVE
Practice Address - Street 2:
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-1846
Practice Address - Country:US
Practice Address - Phone:269-783-6225
Practice Address - Fax:269-926-8129
Is Sole Proprietor?:No
Enumeration Date:2019-01-26
Last Update Date:2019-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN