Provider Demographics
NPI:1649678277
Name:BIRKENHAUER, MARY RACHAEL (CLC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:RACHAEL
Last Name:BIRKENHAUER
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1222 HARBOUR DR
Mailing Address - Street 2:303
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7780
Mailing Address - Country:US
Mailing Address - Phone:614-717-8487
Mailing Address - Fax:
Practice Address - Street 1:1222 HARBOUR DR
Practice Address - Street 2:303
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7780
Practice Address - Country:US
Practice Address - Phone:614-717-8487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-14
Last Update Date:2014-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15-00038862174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN