Provider Demographics
NPI:1578969770
Name:HIESTAND, PATRICIA A (RN, BSN, IBCLC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:HIESTAND
Suffix:
Gender:F
Credentials:RN, BSN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6161 GLACIER PL
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98248-8321
Mailing Address - Country:US
Mailing Address - Phone:360-393-8144
Mailing Address - Fax:
Practice Address - Street 1:2376 MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:FERNDALE
Practice Address - State:WA
Practice Address - Zip Code:98248-8605
Practice Address - Country:US
Practice Address - Phone:360-393-8144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-15
Last Update Date:2014-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00147691163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant