Provider Demographics
NPI:1669241956
Name:GOLMAN, MANDY ALEEZA (PHD, RN, IBCLC)
Entity type:Individual
Prefix:
First Name:MANDY
Middle Name:ALEEZA
Last Name:GOLMAN
Suffix:
Gender:F
Credentials:PHD, RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6915 LAVENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-3543
Mailing Address - Country:US
Mailing Address - Phone:214-803-3139
Mailing Address - Fax:
Practice Address - Street 1:6915 LAVENDALE AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-3543
Practice Address - Country:US
Practice Address - Phone:214-803-3139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-27
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1080341163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant