Provider Demographics
NPI:1447563804
Name:VANDERLUGT, KAREN SUE (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:SUE
Last Name:VANDERLUGT
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5274 DRIFTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-1222
Mailing Address - Country:US
Mailing Address - Phone:269-372-8384
Mailing Address - Fax:
Practice Address - Street 1:1441 S WESTNEDGE AVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-1370
Practice Address - Country:US
Practice Address - Phone:269-381-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704155712163W00000X
VA10943727163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant