Provider Demographics
NPI:1508556184
Name:NUNES, MYLINDA (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:MYLINDA
Middle Name:
Last Name:NUNES
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 1:13731 S EGLANTINA DR
Mailing Address - Street 2:
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84096-1759
Mailing Address - Country:US
Mailing Address - Phone:801-842-2325
Mailing Address - Fax:
Practice Address - Street 1:13731 S EGLANTINA DR
Practice Address - Street 2:
Practice Address - City:HERRIMAN
Practice Address - State:UT
Practice Address - Zip Code:84096-1759
Practice Address - Country:US
Practice Address - Phone:801-842-2325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5319560-3102163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant