Provider Demographics
NPI:1851657720
Name:CHISOLM, KATIE IRENE (IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:IRENE
Last Name:CHISOLM
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 1:565 MCINTOSH RD
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:NC
Mailing Address - Zip Code:28327-8594
Mailing Address - Country:US
Mailing Address - Phone:910-245-7276
Mailing Address - Fax:
Practice Address - Street 1:565 MCINTOSH RD
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:NC
Practice Address - Zip Code:28327-8594
Practice Address - Country:US
Practice Address - Phone:910-245-7276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN