Provider Demographics
NPI:1609169622
Name:ROBERTS, ANGELINE MARIE (IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:ANGELINE
Middle Name:MARIE
Last Name:ROBERTS
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 1:4721 LANDSBERRY LN
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-6741
Mailing Address - Country:US
Mailing Address - Phone:402-450-3240
Mailing Address - Fax:
Practice Address - Street 1:4721 LANDSBERRY LN
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-6741
Practice Address - Country:US
Practice Address - Phone:402-450-3240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10954877174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN