Provider Demographics
NPI:1518784164
Name:ELDARRAT, DEBORAH (IBCLC)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:ELDARRAT
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 1:634 MENDELSSOHN DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63122-2544
Mailing Address - Country:US
Mailing Address - Phone:314-825-4906
Mailing Address - Fax:
Practice Address - Street 1:634 MENDELSSOHN DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122-2544
Practice Address - Country:US
Practice Address - Phone:314-825-4906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOL-302788163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty