Provider Demographics
NPI:1265157010
Name:NELOMS, AMY-EUNICE (IBCLC)
Entity type:Individual
Prefix:
First Name:AMY-EUNICE
Middle Name:
Last Name:NELOMS
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 1:18331 WARRINGTON DR
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-3723
Mailing Address - Country:US
Mailing Address - Phone:313-643-0014
Mailing Address - Fax:
Practice Address - Street 1:18930 ROSELAWN ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-2120
Practice Address - Country:US
Practice Address - Phone:313-643-0014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-04
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL-307188174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty