Provider Demographics
NPI:1750783643
Name:KENYON, CHRISTINE L (MA,IBCLC)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:L
Last Name:KENYON
Suffix:
Gender:F
Credentials:MA,IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 ARLENE DR
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94595-1731
Mailing Address - Country:US
Mailing Address - Phone:650-303-6114
Mailing Address - Fax:
Practice Address - Street 1:132 ARLENE DR
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94595-1731
Practice Address - Country:US
Practice Address - Phone:650-303-6114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL-22217174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN