Provider Demographics
NPI:1295094399
Name:GASS, THERESE SUE (RN, IBCLC, RLC)
Entity type:Individual
Prefix:MRS
First Name:THERESE
Middle Name:SUE
Last Name:GASS
Suffix:
Gender:F
Credentials:RN, IBCLC, RLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6234 PARIMA ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-2108
Mailing Address - Country:US
Mailing Address - Phone:661-755-3110
Mailing Address - Fax:
Practice Address - Street 1:6234 PARIMA ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-2108
Practice Address - Country:US
Practice Address - Phone:661-755-3110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-09
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA303569163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant