Provider Demographics
NPI:1104541747
Name:DOERR, MICHELLE ELAINE (IBCLC/RN)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ELAINE
Last Name:DOERR
Suffix:
Gender:F
Credentials:IBCLC/RN
Other - Prefix:
Other - First Name:SHELLI
Other - Middle Name:ELAINE
Other - Last Name:DOERR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:IBCLC/RN
Mailing Address - Street 1:306 APACHE TRL
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-2387
Mailing Address - Country:US
Mailing Address - Phone:512-497-3177
Mailing Address - Fax:
Practice Address - Street 1:301 BRUSHY CREEK RD STE 106
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-3151
Practice Address - Country:US
Practice Address - Phone:512-765-9959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL-303660163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant