Provider Demographics
NPI:1972954360
Name:VAN ROOYEN, CLAIRE EMMA (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:EMMA
Last Name:VAN ROOYEN
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 1:2012 SILVERLAKE WAY
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-5434
Mailing Address - Country:US
Mailing Address - Phone:415-215-7190
Mailing Address - Fax:
Practice Address - Street 1:2012 SILVERLAKE WAY
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-5434
Practice Address - Country:US
Practice Address - Phone:415-215-7190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA685282163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant