Provider Demographics
NPI:1851677256
Name:GERMAN, SHIRLEY (IBCLC)
Entity type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:
Last Name:GERMAN
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 1:1001 OESTE DR
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-1852
Mailing Address - Country:US
Mailing Address - Phone:530-220-0747
Mailing Address - Fax:
Practice Address - Street 1:1001 OESTE DR
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-1852
Practice Address - Country:US
Practice Address - Phone:530-220-0747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-29
Last Update Date:2011-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
11175928OtherINTERNATIONAL BOARD OF LACTATION CONSULTANT EXAMINERS