Provider Demographics
NPI:1295458909
Name:SIMMS, NATISHA JEANENE (IBCLC)
Entity type:Individual
Prefix:
First Name:NATISHA
Middle Name:JEANENE
Last Name:SIMMS
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 1:6130 GOLD WAGON LN
Mailing Address - Street 2:
Mailing Address - City:MINT HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28227-9314
Mailing Address - Country:US
Mailing Address - Phone:202-491-7457
Mailing Address - Fax:
Practice Address - Street 1:10887 GARDEN OAKS LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-4845
Practice Address - Country:US
Practice Address - Phone:202-491-7457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-301194174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN