Provider Demographics
NPI:1154042091
Name:WERDMULLER VON ELGG, STEFANIE C (IBCLC)
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:C
Last Name:WERDMULLER VON ELGG
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1138 DIAMOND AVE APT A
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-5719
Mailing Address - Country:US
Mailing Address - Phone:626-831-0068
Mailing Address - Fax:
Practice Address - Street 1:1138 DIAMOND AVE APT A
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-5719
Practice Address - Country:US
Practice Address - Phone:626-831-0068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN