Provider Demographics
NPI:1548606023
Name:VELASQUEZ, LISA STAGER (IBCLC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:STAGER
Last Name:VELASQUEZ
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 1:3132 E WELLS RD
Mailing Address - Street 2:
Mailing Address - City:WELLS
Mailing Address - State:VT
Mailing Address - Zip Code:05774-3826
Mailing Address - Country:US
Mailing Address - Phone:802-325-2566
Mailing Address - Fax:
Practice Address - Street 1:3132 E WELLS RD
Practice Address - Street 2:
Practice Address - City:WELLS
Practice Address - State:VT
Practice Address - Zip Code:05774-3826
Practice Address - Country:US
Practice Address - Phone:802-325-2566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-11
Last Update Date:2013-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN