Individual
MISHELL GREENVILLE WHITACRE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LM, IBCLC
Contact information
Practice address
4665 PORTOLA WAY, ATASCADERO, CA 93422-2300
(805) 400-8231
Mailing address
4665 PORTOLA WAY, ATASCADERO, CA 93422-2300
(805) 400-8231
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
Primary
LM502
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
L-62666
BOARD CERTIFIED LACTATION CONSULTANT
CA
01
—
LM502
MIDWIFE LICENSE
CA
Enumeration date
10/31/2017
Last updated
10/31/2017
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