Provider Demographics
NPI:1437713468
Name:UNG, KRISTA S (IBCLC)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:S
Last Name:UNG
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:S
Other - Last Name:UNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:IBCLC
Mailing Address - Street 1:5317 HIGHGATE DR STE 115
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6622
Mailing Address - Country:US
Mailing Address - Phone:919-864-8361
Mailing Address - Fax:
Practice Address - Street 1:5317 HIGHGATE DR STE 115
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-6622
Practice Address - Country:US
Practice Address - Phone:704-864-8361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL-111135174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN