Provider Demographics
NPI:1497129449
Name:SUNDERLAND, KARA (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:SUNDERLAND
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 1:17214 RUSSET ST.
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127
Mailing Address - Country:US
Mailing Address - Phone:858-247-1417
Mailing Address - Fax:
Practice Address - Street 1:17214 RUSSET ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-2140
Practice Address - Country:US
Practice Address - Phone:858-247-1417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA843684163W00000X, 163WM1400X
ZZL-77765163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163W00000XNursing Service ProvidersRegistered Nurse
No163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)