Provider Demographics
NPI:1649526542
Name:FONDER, ALICIA S (RN, IBCLC, LCCE)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:S
Last Name:FONDER
Suffix:
Gender:F
Credentials:RN, IBCLC, LCCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 S 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-1905
Mailing Address - Country:US
Mailing Address - Phone:605-553-8364
Mailing Address - Fax:
Practice Address - Street 1:1707 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1905
Practice Address - Country:US
Practice Address - Phone:605-553-8364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-28
Last Update Date:2012-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR029824163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant