Provider Demographics
NPI:1679919757
Name:CARY, LISA (IBCLC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:CARY
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 1:4201 MONTREAL ST APT 202
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-0346
Mailing Address - Country:US
Mailing Address - Phone:218-310-1987
Mailing Address - Fax:
Practice Address - Street 1:4201 MONTREAL ST APT 202
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0346
Practice Address - Country:US
Practice Address - Phone:218-310-1987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11215444174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN