Provider Demographics
NPI:1629806120
Name:COONS, HEATHER (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:COONS
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:CAMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:18 CHRISEMILY LN
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:VT
Mailing Address - Zip Code:05468-3794
Mailing Address - Country:US
Mailing Address - Phone:802-370-0709
Mailing Address - Fax:
Practice Address - Street 1:18 CHRISEMILY LN
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:VT
Practice Address - Zip Code:05468-3794
Practice Address - Country:US
Practice Address - Phone:802-370-0709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-25
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT026.0087352163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
Provider Identifiers
StateIdentifier IDID TypeIssuer
L-315940OtherIBCLE