Provider Demographics
NPI:1083329411
Name:KULA-IMTIAZ, ASHLEY (IBCLC)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:KULA-IMTIAZ
Suffix:
Gender:
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 E CAMPBELL ST STE 215
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-4660
Mailing Address - Country:US
Mailing Address - Phone:405-326-9618
Mailing Address - Fax:
Practice Address - Street 1:217 E CAMPBELL ST STE 215
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-4660
Practice Address - Country:US
Practice Address - Phone:405-326-9618
Practice Address - Fax:405-896-9377
Is Sole Proprietor?:No
Enumeration Date:2023-01-19
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-309216174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN