Provider Demographics
NPI:1508434853
Name:HART, ANGELA (IBCLC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:HART
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ANGELA
Other - Last Name:HART
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:IBCLC
Mailing Address - Street 1:2143 HURLEY WAY STE 110
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-3299
Mailing Address - Country:US
Mailing Address - Phone:916-326-5830
Mailing Address - Fax:
Practice Address - Street 1:2143 HURLEY WAY STE 110
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-3299
Practice Address - Country:US
Practice Address - Phone:916-326-5830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN