Provider Demographics
NPI:1881943231
Name:ROSELLI, VICTORIA ANNE (IBCLC)
Entity type:Individual
Prefix:MISS
First Name:VICTORIA
Middle Name:ANNE
Last Name:ROSELLI
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:PO BOX 6162
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60567-6162
Mailing Address - Country:US
Mailing Address - Phone:847-624-2467
Mailing Address - Fax:
Practice Address - Street 1:1807 PRAIRIE ST
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-2921
Practice Address - Country:US
Practice Address - Phone:847-624-2467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-30
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL11061963174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN