Provider Demographics
NPI:1679357370
Name:WEBER, KRISTIN (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:WEBER
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 1:582 BECKLEE DR
Mailing Address - Street 2:
Mailing Address - City:NAPOLEON
Mailing Address - State:OH
Mailing Address - Zip Code:43545-9129
Mailing Address - Country:US
Mailing Address - Phone:419-388-3479
Mailing Address - Fax:
Practice Address - Street 1:112 E DUDLEY ST
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-3366
Practice Address - Country:US
Practice Address - Phone:419-515-5375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.367346163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant