Provider Demographics
NPI:1922380351
Name:UPTON, DIANE (RN IBCLC)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:UPTON
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 1:4101 CAPE LANDING RD
Mailing Address - Street 2:
Mailing Address - City:CASTLE HAYNE
Mailing Address - State:NC
Mailing Address - Zip Code:28429-4514
Mailing Address - Country:US
Mailing Address - Phone:910-632-4095
Mailing Address - Fax:
Practice Address - Street 1:4101 CAPE LANDING RD
Practice Address - Street 2:
Practice Address - City:CASTLE HAYNE
Practice Address - State:NC
Practice Address - Zip Code:28429-4514
Practice Address - Country:US
Practice Address - Phone:910-632-4095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC136554-108-93953163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant