Provider Demographics
NPI:1942543392
Name:DAVIS, LILLIAN M (IBCLC)
Entity Type:Individual
Prefix:MS
First Name:LILLIAN
Middle Name:M
Last Name:DAVIS
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 1:3636 OLD FORGE RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-3132
Mailing Address - Country:US
Mailing Address - Phone:757-374-8397
Mailing Address - Fax:
Practice Address - Street 1:3636 OLD FORGE RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-3132
Practice Address - Country:US
Practice Address - Phone:757-374-8397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-04
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN