Provider Demographics
NPI:1720646417
Name:PICARD, ANTOINETTE MARIE (IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:ANTOINETTE
Middle Name:MARIE
Last Name:PICARD
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 1:43 CEMETERY LN
Mailing Address - Street 2:
Mailing Address - City:SCHWENKSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19473-1730
Mailing Address - Country:US
Mailing Address - Phone:610-389-6946
Mailing Address - Fax:
Practice Address - Street 1:43 CEMETERY LN
Practice Address - Street 2:
Practice Address - City:SCHWENKSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19473-1730
Practice Address - Country:US
Practice Address - Phone:610-389-6946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAL-137586163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant