Provider Demographics
NPI:1588498257
Name:ZANDBERG, KERRI (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:
Last Name:ZANDBERG
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6541 HARTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-9024
Mailing Address - Country:US
Mailing Address - Phone:810-399-2017
Mailing Address - Fax:
Practice Address - Street 1:142 BRIGHTON LAKE RD
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-1738
Practice Address - Country:US
Practice Address - Phone:810-399-2017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704372525163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant