MARY WAGNER-DAVIS (NPI# 1649697475) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649697475 |
| Entity Type | Individual |
| Full Name | MARY WAGNER-DAVIS |
| Credential | IBCLC |
| Practice Address |
604 Fifteen Mile Dr Roseville CA 95678-5921 |
| Mailing Address |
Po Box 176 Roseville CA 95661-0176 |
| Practice Telephone | 9162768016 |
| Mailing Telephone | 9162768016 |
| Enumeration Date | 2014-03-18 |
| Last Update Date | 2014-03-18 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 106H00000X | Marriage & Family Therapist | MFC23253 | CA | Behavioral Health & Social Service Providers |
| Y | 174N00000X | Lactation Consultant, Non-RN | 10218838 | CA | Other Service Providers |
| Street Address |
604 FIFTEEN MILE DR |
| City | ROSEVILLE |
| State | CA |
| Zip Code | 95678-5921 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114533064 | Alexander V. Antipov, D.d.s., Inc. | Dentist | 911 Reserve Drive, Suite 150, Roseville, CA 95678 | 2020-09-16 |
| 1396378980 | David F Shirley M D P C | Family Medicine | 4001 Impala Circle, Roseville, CA 95678 | 2020-02-21 |
| 1083256051 | Rosemary Ellen Robben | Community Health Worker | Cirby Wellness Center 101 Cirby Hills Drive, Roseville, CA 95678 | 2019-10-11 |
| 1588217236 | Kaiser Foundation Health Plan Inc | Pharmacy | 1021 Riverside Ave, Roseville, CA 95678 | 2019-07-22 |
| 1174093793 | Neftali Hernandez | Behavior Technician | 1100 Roseville Parkway Apt 1021, Roseville, CA 95678 | 2018-11-26 |
| 1467951798 | Amarantha Martinez | Behavior Technician | 1900 Quail Ridge Road, #99, Roseville, CA 95678 | 2018-02-01 |
| 1093231276 | Compassionate Home Health, Ltd | Home Health | 1100 Melody Lane, Suite 106, Roseville, CA 95678 | 2017-08-18 |
| 1629598891 | Jimena Andrade Martins | Behavior Technician | 602 Atkinson Street, Roseville, CA 95678 | 2017-06-20 |
| 1891221057 | Zride Inc | Taxi | 106 Church Street, Suite 2, Roseville, CA 95678 | 2017-05-10 |
| 1568997641 | Joline Trinh | Pharmacist | 1030 Pleasant Grove Boulevard, Roseville, CA 95678 | 2017-04-26 |
| Find all providers in zip 95678 | ||||
| Taxonomy Code | 174N00000X |
| Grouping | Other Service Providers |
| Classification | Lactation Consultant, Non-RN |
| An individual trained to provide breastfeeding assistance services to both mothers and infants. Lactation Consultants are not required to be nurses and are trained through specific courses of education. The Lactation Consultant may have additional certification through a national or international organization. |
| Notes: Source: National Uniform Claim Committee [1/1/2011: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841810736 | Mallory Engel | Lactation Consultant, Non-RN | 316 Princeton Ct, Roseville, CA 95661-7760 | 2020-04-20 |
| 1275073744 | Gina Aiuto | Lactation Consultant, Non-RN | 18235 Marquette St, Roseville, MI 48066-3400 | 2017-03-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154922722 | Ashley Elizabeth Tehrani | Lactation Consultant, Non-RN | 3722 Arnold Ave Apt 5, San Diego, CA 92104-3481 | 2020-11-02 |
| 1760083216 | Teresa Marie Peters | Lactation Consultant, Non-RN | 1120 S Santa Anita Ave Apt A, Arcadia, CA 91006-4029 | 2020-11-02 |
| 1982203667 | Paula Conriquez | Lactation Consultant, Non-RN | 6230 Drop Off Rd, Pollock Pines, CA 95726-9633 | 2020-10-22 |
| 1265031397 | Arabella Hancock | Lactation Consultant, Non-RN | 1038 Rose Ave, Pasadena, CA 91107-1867 | 2020-10-20 |
| 1194331314 | Madison Benstead | Lactation Consultant, Non-RN | 26672 Fino Ct, Redlands, CA 92373-4318 | 2020-09-22 |
| 1952917189 | Kayla Benado | Lactation Consultant, Non-RN | 4653 California Blvd, Santa Maria, CA 93455-4158 | 2020-09-22 |
| 1376152835 | Rebecca Howell | Lactation Consultant, Non-RN | 4811 N Bellflower Blvd, Long Beach, CA 90808-1121 | 2020-07-30 |
| 1740898659 | Heidi Burke-pevney | Lactation Consultant, Non-RN | 1808 Sheridan Way, San Marcos, CA 92078-0929 | 2020-07-16 |
| 1942828140 | Megan Zoe Barrett | Lactation Consultant, Non-RN | 49 Bonita Ave, Piedmont, CA 94611-3947 | 2020-07-14 |
| 1225659840 | Antonina Proshak | Lactation Consultant, Non-RN | 811 Grand Ave Ste A1, Sacramento, CA 95838-3466 | 2020-05-05 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.