Provider Demographics
NPI:1033971213
Name:DE FAYMOREAU, NICOLE AIKO (IBCLC)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:AIKO
Last Name:DE FAYMOREAU
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 1:4154 PIEDMONT AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-5171
Mailing Address - Country:US
Mailing Address - Phone:510-220-3108
Mailing Address - Fax:
Practice Address - Street 1:4154 PIEDMONT AVE APT 7
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-5171
Practice Address - Country:US
Practice Address - Phone:510-220-3108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA313424174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN