Provider Demographics
NPI:1801428503
Name:WHITEHOUSE, SARA (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:WHITEHOUSE
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 RAMONA WAY
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92057-7377
Mailing Address - Country:US
Mailing Address - Phone:229-292-9119
Mailing Address - Fax:
Practice Address - Street 1:153 RAMONA WAY
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92057-7377
Practice Address - Country:US
Practice Address - Phone:229-292-9119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN95134261163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant