Provider Demographics
NPI:1437764263
Name:LOESELL, MARIA PARDO (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:PARDO
Last Name:LOESELL
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:JAZMIN
Other - Last Name:PARDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:18413 66TH PL W
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-4239
Mailing Address - Country:US
Mailing Address - Phone:206-228-1196
Mailing Address - Fax:
Practice Address - Street 1:18413 66TH PL W
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-4239
Practice Address - Country:US
Practice Address - Phone:206-228-1196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00173569163WL0100X
WAL-143378163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant