Provider Demographics
NPI:1962164467
Name:ALLEN, JUANITA NICOLE (IBCLC)
Entity type:Individual
Prefix:
First Name:JUANITA
Middle Name:NICOLE
Last Name:ALLEN
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 1:2602 CAPLIN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77026-1104
Mailing Address - Country:US
Mailing Address - Phone:979-703-9123
Mailing Address - Fax:
Practice Address - Street 1:2602 CAPLIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77026-1104
Practice Address - Country:US
Practice Address - Phone:979-703-9123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-12
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-308020174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN