Provider Demographics
NPI:1194321828
Name:MERIDETH, EMILY (RN-C, IBCLC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:MERIDETH
Suffix:
Gender:F
Credentials:RN-C, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5544 LAWTON AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-1509
Mailing Address - Country:US
Mailing Address - Phone:510-333-4392
Mailing Address - Fax:
Practice Address - Street 1:MOTHER-BABY UNIT
Practice Address - Street 2:1601 YGNACIO VALLEY ROAD
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA556855163WM0102X
CAL-22704163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn