Provider Demographics
NPI:1598389884
Name:DYMOND, ALYCIA (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:ALYCIA
Middle Name:
Last Name:DYMOND
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 1:147 COLON ST
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-3632
Mailing Address - Country:US
Mailing Address - Phone:415-894-9029
Mailing Address - Fax:
Practice Address - Street 1:147 COLON ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-3632
Practice Address - Country:US
Practice Address - Phone:415-894-9029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-02
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2304530163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant