Provider Demographics
NPI:1457637548
Name:ELBL, TRICIA LYNNE (IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:TRICIA
Middle Name:LYNNE
Last Name:ELBL
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 1:8 KINSMAN PL
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-2703
Mailing Address - Country:US
Mailing Address - Phone:630-329-6643
Mailing Address - Fax:508-653-2045
Practice Address - Street 1:8 KINSMAN PL
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-2703
Practice Address - Country:US
Practice Address - Phone:630-329-6643
Practice Address - Fax:508-653-2045
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-02
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL11146577174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN