Provider Demographics
NPI:1063715084
Name:BURTON, WINIFRED GLORY BELZONIA (IBCLC, NAC)
Entity type:Individual
Prefix:
First Name:WINIFRED
Middle Name:GLORY BELZONIA
Last Name:BURTON
Suffix:
Gender:F
Credentials:IBCLC, NAC
Other - Prefix:
Other - First Name:TANISHA
Other - Middle Name:RENEE
Other - Last Name:GRICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:805 LAKE ST UNIT 1044
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1301
Mailing Address - Country:US
Mailing Address - Phone:313-327-2325
Mailing Address - Fax:
Practice Address - Street 1:805 LAKE ST UNIT 1044
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1301
Practice Address - Country:US
Practice Address - Phone:313-327-2325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-13
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X, 376K00000X
WA11099970174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No374J00000XNursing Service Related ProvidersDoula
No376K00000XNursing Service Related ProvidersNurse's Aide