Provider Demographics
NPI:1427770007
Name:SKINNER, HOLLY BREANNE (IBCLC)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:BREANNE
Last Name:SKINNER
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 1:608 SW 150TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-7531
Mailing Address - Country:US
Mailing Address - Phone:405-289-8891
Mailing Address - Fax:
Practice Address - Street 1:608 SW 150TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170-7531
Practice Address - Country:US
Practice Address - Phone:405-289-8891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKL-302143174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKL-302143OtherIBCLC CERT