Provider Demographics
NPI:1629846159
Name:GEROLEMON, MACEY BLAKE (IBCLC)
Entity Type:Individual
Prefix:
First Name:MACEY
Middle Name:BLAKE
Last Name:GEROLEMON
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3583 SUGAR TREE PL
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-1376
Mailing Address - Country:US
Mailing Address - Phone:919-349-3145
Mailing Address - Fax:
Practice Address - Street 1:7345 INTERNATIONAL PL # 1097345
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34240-8467
Practice Address - Country:US
Practice Address - Phone:941-254-2502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN