Provider Demographics
NPI:1588844419
Name:GARRISON, URSULA A (IBCLC, RLC)
Entity Type:Individual
Prefix:
First Name:URSULA
Middle Name:A
Last Name:GARRISON
Suffix:
Gender:F
Credentials:IBCLC, RLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 GREGG ST
Mailing Address - Street 2:
Mailing Address - City:SHILLINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19607-1334
Mailing Address - Country:US
Mailing Address - Phone:610-777-9541
Mailing Address - Fax:
Practice Address - Street 1:518 GREGG ST
Practice Address - Street 2:
Practice Address - City:SHILLINGTON
Practice Address - State:PA
Practice Address - Zip Code:19607-1334
Practice Address - Country:US
Practice Address - Phone:610-777-9541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA103-20072174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist