MEDICARE: PIKES PEAK LACTATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174N00000X	Lactation Consultant (Non-RN)
2	163WL0100X	Lactation Consultant (Registered Nurse)

General Provider Information

NPI Number	:	1023740685
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PIKES PEAK LACTATION

Provider Business Mailing Address
First Line	:	521 W RAMONA AVE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80905-2031
Country	:	US
Telephone Number	:	719-321-6143
Fax Number	:	719-960-3068

Provider Business Practice Location Address
First Line	:	521 W RAMONA AVE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80905-2031
Country	:	US
Telephone Number	:	719-321-6143
Fax Number	:	719-960-3068

Authorized Official
Title or Position	:	OWNER, LACTATION CONSULTANT
Name	:	MARY M ENGER
Credential	:	RN, BSN, IBCLC
Telephone Number	:	719-321-6143

Provider Enumeration Date	:	06/30/2022
Last Update Date	:	06/30/2022

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Directions to “PIKES PEAK LACTATION ” Practice Location

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