Provider Demographics
NPI:1962809418
Name:STANTON, DONNA (RN,IBCLC)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:STANTON
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 1:9514 LAWNDALE AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60203-1007
Mailing Address - Country:US
Mailing Address - Phone:847-606-6818
Mailing Address - Fax:
Practice Address - Street 1:9514 LAWNDALE AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60203-1007
Practice Address - Country:US
Practice Address - Phone:847-606-6818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-28
Last Update Date:2014-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041175724163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant