Provider Demographics
NPI:1952798738
Name:DERIFIELD, CYNTHIA SUE (IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:SUE
Last Name:DERIFIELD
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 1:56 TOWNSHIP ROAD 316
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638-8967
Mailing Address - Country:US
Mailing Address - Phone:740-533-0662
Mailing Address - Fax:740-532-0450
Practice Address - Street 1:56 TOWNSHIP ROAD 316
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-8967
Practice Address - Country:US
Practice Address - Phone:740-533-0662
Practice Address - Fax:740-532-0450
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10218035163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant