Individual
SENECA ISLA ROSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
IBCLC
Contact information
Practice address
32513 RAILROAD AVE, BLACK DIAMOND, WA 98010-9762
(360) 851-9896
Mailing address
PO BOX 881, BLACK DIAMOND, WA 98010
(360) 851-9896
Taxonomy
Speciality
Code
Description
License number
State
174N00000X
Lactation Consultant (Non-RN)
Primary
L-307027
WA
Other
Enumeration date
03/16/2023
Last updated
03/16/2023
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