Provider Demographics
NPI:1538992953
Name:ANNIS, JOEDY M (IBCLC)
Entity type:Individual
Prefix:MRS
First Name:JOEDY
Middle Name:M
Last Name:ANNIS
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 1:2715 PINE BREEZE DR
Mailing Address - Street 2:
Mailing Address - City:INTERLOCHEN
Mailing Address - State:MI
Mailing Address - Zip Code:49643-9786
Mailing Address - Country:US
Mailing Address - Phone:231-944-2875
Mailing Address - Fax:
Practice Address - Street 1:2715 PINE BREEZE DR
Practice Address - Street 2:
Practice Address - City:INTERLOCHEN
Practice Address - State:MI
Practice Address - Zip Code:49643-9786
Practice Address - Country:US
Practice Address - Phone:231-944-2875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL302421163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant