Provider Demographics
NPI:1770755001
Name:FARMER, ATHENA RENAE (IBCLC)
Entity type:Individual
Prefix:MRS
First Name:ATHENA
Middle Name:RENAE
Last Name:FARMER
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 1:266 NUNNER RD
Mailing Address - Street 2:
Mailing Address - City:MAINEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45039-8633
Mailing Address - Country:US
Mailing Address - Phone:513-774-0012
Mailing Address - Fax:
Practice Address - Street 1:266 NUNNER RD
Practice Address - Street 2:
Practice Address - City:MAINEVILLE
Practice Address - State:OH
Practice Address - Zip Code:45039-8633
Practice Address - Country:US
Practice Address - Phone:513-774-0012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-233283163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant