Individual
MS. HEATHER ANN BUQUOI-ELLISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
IBCLC
Contact information
Practice address
4159 STECK AVE, UNIT 111, AUSTIN, TX 78759-8585
(225) 620-7589
Mailing address
4159 STECK AVE, UNIT 111, AUSTIN, TX 78759-8585
(225) 620-7589
Taxonomy
Speciality
Code
Description
License number
State
174N00000X
Lactation Consultant (Non-RN)
Primary
11198976
TX
Other
Enumeration date
11/12/2015
Last updated
11/12/2015
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