Provider Demographics
NPI:1609528231
Name:ANDERSON, RACHEL (IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:
Last Name:ANDERSON
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 1:14105 SHAW DR
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-0625
Mailing Address - Country:US
Mailing Address - Phone:661-993-2880
Mailing Address - Fax:
Practice Address - Street 1:14105 SHAW DR
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-0625
Practice Address - Country:US
Practice Address - Phone:661-993-2880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL-143877174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC236Medicaid