Provider Demographics
NPI:1477036168
Name:WILKES, MOIRA FISCHMAN (IBCLC)
Entity Type:Individual
Prefix:
First Name:MOIRA
Middle Name:FISCHMAN
Last Name:WILKES
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 1:1177 QUEEN ST APT 2006
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4144
Mailing Address - Country:US
Mailing Address - Phone:941-376-4053
Mailing Address - Fax:
Practice Address - Street 1:1177 QUEEN ST APT 2006
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4144
Practice Address - Country:US
Practice Address - Phone:941-376-4053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-85670174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN