Provider Demographics
NPI:1962274423
Name:DEMEIS, JEANETTE ELIZABETH (IBCLC)
Entity type:Individual
Prefix:MRS
First Name:JEANETTE
Middle Name:ELIZABETH
Last Name:DEMEIS
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 1:20112 E 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:WA
Mailing Address - Zip Code:99016-5291
Mailing Address - Country:US
Mailing Address - Phone:949-537-6526
Mailing Address - Fax:
Practice Address - Street 1:2607 S SOUTHEAST BLVD STE B150
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-4987
Practice Address - Country:US
Practice Address - Phone:509-954-5337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-308006174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN