Provider Demographics
NPI:1649059635
Name:HERNLUND, DEBRA KAY (IBCLC)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:KAY
Last Name:HERNLUND
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 1:29 MONTELAGO BLVD UNIT 431
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89011-3243
Mailing Address - Country:US
Mailing Address - Phone:216-571-9997
Mailing Address - Fax:
Practice Address - Street 1:29 MONTELAGO BLVD UNIT 431
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89011-3243
Practice Address - Country:US
Practice Address - Phone:216-571-9997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-17222174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty