Provider Demographics
NPI:1841583598
Name:MALLIN, NANCY LUCILLE (IBCLC)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:LUCILLE
Last Name:MALLIN
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 1:4217 BROOKFIELD DR
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-4011
Mailing Address - Country:US
Mailing Address - Phone:301-897-3533
Mailing Address - Fax:
Practice Address - Street 1:4217 BROOKFIELD DR
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-4011
Practice Address - Country:US
Practice Address - Phone:301-897-3533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11098812174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN