Provider Demographics
NPI:1942555362
Name:MENDENHALL, AUGUSTA (IBCLC)
Entity type:Individual
Prefix:MRS
First Name:AUGUSTA
Middle Name:
Last Name:MENDENHALL
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 1:2191 EQUINOX TRCE APT 1C
Mailing Address - Street 2:
Mailing Address - City:COLFAX
Mailing Address - State:NC
Mailing Address - Zip Code:27235-0015
Mailing Address - Country:US
Mailing Address - Phone:919-636-8900
Mailing Address - Fax:
Practice Address - Street 1:2191 EQUINOX TRCE APT 1C
Practice Address - Street 2:
Practice Address - City:COLFAX
Practice Address - State:NC
Practice Address - Zip Code:27235-0015
Practice Address - Country:US
Practice Address - Phone:919-636-8900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-23
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-12364174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN