Provider Demographics
NPI:1417614405
Name:OSTERMAYER, DARA MICHELLE (BSN, RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:DARA
Middle Name:MICHELLE
Last Name:OSTERMAYER
Suffix:
Gender:F
Credentials:BSN, RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13417 MOUNT VERNON ST
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:TX
Mailing Address - Zip Code:77510-7924
Mailing Address - Country:US
Mailing Address - Phone:832-799-8835
Mailing Address - Fax:
Practice Address - Street 1:250 BLOSSOM ST STE 350
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4243
Practice Address - Country:US
Practice Address - Phone:832-505-3010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-24
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAL-303730163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant