Provider Demographics
NPI:1558955948
Name:KOSTER, MARY HUNTER (RN, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:HUNTER
Last Name:KOSTER
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 1:1004 BROOKSIDE DR NW
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-2112
Mailing Address - Country:US
Mailing Address - Phone:252-230-5358
Mailing Address - Fax:
Practice Address - Street 1:1004 BROOKSIDE DR NW
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-2112
Practice Address - Country:US
Practice Address - Phone:252-230-5358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC217679163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty