Provider Demographics
NPI:1740898659
Name:BURKE-PEVNEY, HEIDI (IBCLC)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:BURKE-PEVNEY
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 1:1808 SHERIDAN WAY
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-0929
Mailing Address - Country:US
Mailing Address - Phone:760-443-8683
Mailing Address - Fax:
Practice Address - Street 1:1808 SHERIDAN WAY
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-0929
Practice Address - Country:US
Practice Address - Phone:760-443-8683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-16
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL-13603174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN