Provider Demographics
NPI:1134889488
Name:MAWSON, KAREN MADISON (IBCLC)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:MADISON
Last Name:MAWSON
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 1:2735 RIVERCLIFF RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-3354
Mailing Address - Country:US
Mailing Address - Phone:704-219-6680
Mailing Address - Fax:
Practice Address - Street 1:154 BOW ST STE C
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-2300
Practice Address - Country:US
Practice Address - Phone:910-849-9221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-28
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAL-301263174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN