Provider Demographics
NPI:1538595327
Name:SHOLES, BETH-ANN (IBCLC)
Entity type:Individual
Prefix:
First Name:BETH-ANN
Middle Name:
Last Name:SHOLES
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:BETH-ANN
Other - Middle Name:
Other - Last Name:BERRIOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 99
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:NV
Mailing Address - Zip Code:89423-0099
Mailing Address - Country:US
Mailing Address - Phone:775-546-2850
Mailing Address - Fax:
Practice Address - Street 1:1664 US HIGHWAY 395 N
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:NV
Practice Address - Zip Code:89423-4314
Practice Address - Country:US
Practice Address - Phone:775-546-2850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
11110541174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN