Provider Demographics
NPI:1790158871
Name:ZUCK, JULIE (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:ZUCK
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 1:1029 FAIRHILL TER
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-6540
Mailing Address - Country:US
Mailing Address - Phone:360-643-3172
Mailing Address - Fax:
Practice Address - Street 1:1029 FAIRHILL TER
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91977-6540
Practice Address - Country:US
Practice Address - Phone:360-643-3172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-11
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL-84078163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant