Provider Demographics
NPI:1174136766
Name:GILBERT, JOHANNA MAE (RN, IBCLC)
Entity type:Individual
Prefix:MRS
First Name:JOHANNA
Middle Name:MAE
Last Name:GILBERT
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2423 TRAM RD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-7374
Mailing Address - Country:US
Mailing Address - Phone:910-650-0425
Mailing Address - Fax:
Practice Address - Street 1:2423 TRAM RD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-7374
Practice Address - Country:US
Practice Address - Phone:910-650-0425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4F1J42OR163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant