Provider Demographics
NPI:1366719247
Name:MACNAIR, GRACE ANNE (IBCLC)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:ANNE
Last Name:MACNAIR
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:ANNE
Other - Last Name:MACNAIR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:IBCLC
Mailing Address - Street 1:302 LINCOLN RD APT 3R
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-4126
Mailing Address - Country:US
Mailing Address - Phone:828-329-0965
Mailing Address - Fax:
Practice Address - Street 1:302 LINCOLN RD APT 2R
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-4126
Practice Address - Country:US
Practice Address - Phone:828-329-0965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-21
Last Update Date:2020-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204997174N00000X
NYL-302325174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYL-302325OtherINTERNATIONAL BOARD OF LACTATION CONSULTANT EXAMINERS