Provider Demographics
NPI:1952894834
Name:MCDONOUGH, LOUISE (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:LOUISE
Middle Name:
Last Name:MCDONOUGH
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 1:1911 W FULLIAM AVE
Mailing Address - Street 2:
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-2408
Mailing Address - Country:US
Mailing Address - Phone:563-299-2757
Mailing Address - Fax:
Practice Address - Street 1:1609 CEDAR ST
Practice Address - Street 2:
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-3426
Practice Address - Country:US
Practice Address - Phone:563-299-2757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA096556163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant