Provider Demographics
NPI:1598527145
Name:MONTEZ, ELIZABETH LAURA (IBCLC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LAURA
Last Name:MONTEZ
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 1:8102 UPPER BAY SHORE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLEVOIX
Mailing Address - State:MI
Mailing Address - Zip Code:49720-9443
Mailing Address - Country:US
Mailing Address - Phone:360-798-0133
Mailing Address - Fax:
Practice Address - Street 1:8102 UPPER BAY SHORE RD
Practice Address - Street 2:
Practice Address - City:CHARLEVOIX
Practice Address - State:MI
Practice Address - Zip Code:49720-9443
Practice Address - Country:US
Practice Address - Phone:360-798-0133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAL-303364174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN