Individual
MISS MADELEINE JUSTINE WISNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LM, IBCLC
Contact information
Practice address
2541 28TH ST #4 SACRAMENTO, SACRAMENTO, CA 95818
(916) 668-9467
(209) 336-6814
Mailing address
5960 SOUTH LAND PARK DRIVE, PMB 302, SACRAMENTO, CA 95822
(916) 668-9467
(209) 336-6814
Taxonomy
Speciality
Code
Description
License number
State
174N00000X
Lactation Consultant (Non-RN)
—
—
176B00000X
Midwife
Primary
510
CA
374J00000X
Doula
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1831618370
—
CA
Enumeration date
09/15/2017
Last updated
01/02/2024
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