Provider Demographics
NPI:1821723099
Name:BIRD, MONICA LYNNE (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:LYNNE
Last Name:BIRD
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 1:2344 LAMMERMOOR LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46214-2290
Mailing Address - Country:US
Mailing Address - Phone:317-993-1162
Mailing Address - Fax:
Practice Address - Street 1:2344 LAMMERMOOR LN
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46214-2290
Practice Address - Country:US
Practice Address - Phone:317-993-1162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28135191A163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant