Provider Demographics
NPI:1679256465
Name:BATES, CECILIA (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:
Last Name:BATES
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 1:1202 N MUSKOGEE PL
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-3058
Mailing Address - Country:US
Mailing Address - Phone:918-343-6914
Mailing Address - Fax:
Practice Address - Street 1:1202 N MUSKOGEE PL
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-3058
Practice Address - Country:US
Practice Address - Phone:918-343-6914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0098020163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant