Provider Demographics
NPI:1710863279
Name:DIB, RENEE (IBCLC)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:DIB
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:RENE
Other - Middle Name:
Other - Last Name:DIB
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:IBCLC
Mailing Address - Street 1:5010 HARVEST KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77389-1642
Mailing Address - Country:US
Mailing Address - Phone:512-586-8137
Mailing Address - Fax:
Practice Address - Street 1:5010 HARVEST KNOLL DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77389-1642
Practice Address - Country:US
Practice Address - Phone:512-586-8137
Practice Address - Fax:512-586-8137
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL-318794174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN