Individual
MS. IDA CAROLINE SUZANNE TRUNICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, IBCLC
Contact information
Practice address
1101 CAMINO LA COSTA, AUSTIN, TX 78752-3930
(512) 684-1744
Mailing address
15060 HALEY HOLW, AUSTIN, TX 78728-4454
Taxonomy
Speciality
Code
Description
License number
State
174N00000X
Lactation Consultant (Non-RN)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
L-35230
IBCLE
—
Enumeration date
08/14/2017
Last updated
08/14/2017
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