Mary Wagner-Davis, IBCLC

Primary specialty

Lactation Consultant (Non-RN)Taxonomy code 174N00000X

License

10218838 Issued in CA

Practice address

604 Fifteen Mile Dr
Roseville, CA 95678-5921

Phone

(916) 276-8016

NPI assigned

Mar 18, 2014

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1395100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395100800000",
    "number": "1649697475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 176",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956610176",
            "telephone_number": "916-276-8016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "604 FIFTEEN MILE DR",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956785921",
            "telephone_number": "916-276-8016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER-DAVIS",
        "first_name": "MARY",
        "credential": "IBCLC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-03-18",
        "last_updated": "2014-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "MFC23253",
            "primary": false
        },
        {
            "code": "174N00000X",
            "taxonomy_group": "",
            "desc": "Lactation Consultant, Non-RN",
            "state": "CA",
            "license": "10218838",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Van H. Vu, M.D.
• Jessica Vue, PA-C
• Tuyen Vuong
• Brooke Wade, RN
• Jeanne Wade, ICCE, CLC, CCE, CD
• Franklin C. Wagner Jr., MD
• Sierra Wagner
• Kristin Alise Wagshul, BCBA
• Eddah Wangeci Waitara, RN,BSN
• Stuart E Wakeman, DDS

• Lactation Consultant (Non-RN) in Roseville, CA
• Providers in Roseville, CA by specialty
• Lactation Consultant (Non-RN) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.