Provider Demographics
NPI:1497003719
Name:GRESHAM, GENA KAY (IBCLC)
Entity Type:Individual
Prefix:MS
First Name:GENA
Middle Name:KAY
Last Name:GRESHAM
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:ZENA
Other - Middle Name:KAY
Other - Last Name:INGRAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:IBCLC
Mailing Address - Street 1:8670 W CHEYENNE AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-7456
Mailing Address - Country:US
Mailing Address - Phone:702-425-2791
Mailing Address - Fax:725-877-2701
Practice Address - Street 1:8670 W CHEYENNE AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-7456
Practice Address - Country:US
Practice Address - Phone:702-425-2791
Practice Address - Fax:725-877-2701
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-16
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
10623419OtherIBCLC