Individual
GAYLE ANNE OWEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN IBCLC LC
Contact information
Practice address
596 BANKSTOWN RD, BROOKS, GA 30205-2219
(770) 856-0890
Mailing address
596 BANKSTOWN RD, BROOKS, GA 30205-2219
(770) 856-0890
Taxonomy
Speciality
Code
Description
License number
State
163WL0100X
Lactation Consultant (Registered Nurse)
Primary
077331
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
28744
LACTATION
GA
Enumeration date
09/22/2020
Last updated
09/22/2020
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