Courtney Marie Wallace, RN, PHN, IBCLC

Primary specialty

Lactation Consultant (Registered Nurse)Taxonomy code 163WL0100X

License

821163 Issued in CA

Practice address

363 Barry Dr
Ventura, CA 93001-1495

Phone

(805) 798-1596

NPI assigned

Jan 15, 2025

Last updated

Jan 15, 2025By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Courtney Marie Hultgen Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1736899200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736899200000",
    "number": "1710798285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "363 BARRY DR",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "930011495",
            "telephone_number": "805-798-1596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "363 BARRY DR",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "930011495",
            "telephone_number": "805-798-1596"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "COURTNEY",
        "middle_name": "MARIE",
        "credential": "RN, PHN, IBCLC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-01-15",
        "last_updated": "2025-01-15",
        "certification_date": "2025-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WL0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Lactation Consultant",
            "state": "CA",
            "license": "821163",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "COURTNEY",
            "last_name": "HULTGEN",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Clifton John Walker, COTA
• Lisa Walker
• Madeleine Rose Walker, PSYD
• Tihele Lee Walkowsky, M.D.
• Jessica Marlene Wall
• Eric Wallace, MD
• Jennifer Katherine Wallace, PA-C
• Matt Wallace
• Phoebe Waller, MS, RD
• Sarah Kathleen Wallington, PT, MPT

• Lactation Consultant (Registered Nurse) in Ventura, CA
• Providers in Ventura, CA by specialty
• Lactation Consultant (Registered Nurse) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2025; 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.