Provider Demographics
NPI:1366073587
Name:CASILLAS, VICTORIA NATALIE (IBCLC)
Entity type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:NATALIE
Last Name:CASILLAS
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 1:240894 COUNTY ROAD G
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-7004
Mailing Address - Country:US
Mailing Address - Phone:308-641-1146
Mailing Address - Fax:
Practice Address - Street 1:240894 COUNTY ROAD G
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-7004
Practice Address - Country:US
Practice Address - Phone:308-641-1146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEL-125076174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty