Provider Demographics
NPI:1285920793
Name:MATTES, SHARON LOIS (IBCLC)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:LOIS
Last Name:MATTES
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 1:1526 ARCHERY LN
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044-7238
Mailing Address - Country:US
Mailing Address - Phone:972-495-2805
Mailing Address - Fax:
Practice Address - Street 1:1526 ARCHERY LN
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044-7238
Practice Address - Country:US
Practice Address - Phone:972-495-2805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10613423174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN