Individual
NICOLE REID
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
IBCLC
Contact information
Practice address
2740 INNISBROOK DR, PORTAGE, MI 49024-7872
(269) 203-5484
Mailing address
2740 INNISBROOK DR, PORTAGE, MI 49024-7872
(269) 203-5484
Taxonomy
Speciality
Code
Description
License number
State
174N00000X
Lactation Consultant (Non-RN)
Primary
108-25456
MN
Other
Enumeration date
03/11/2013
Last updated
03/11/2013
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