MEDICARE: MS. KALLYN ANN LANG IBCLC

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)	L-150012	AK

General Provider Information

NPI Number	:	1093278103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KALLYN ANN LANG IBCLC

Provider Business Mailing Address
First Line	:	PO BOX 873083
Second Line	:
City	:	WASILLA
State	:	AK
Zip	:	99687-3083
Country	:	US
Telephone Number	:	907-978-1343
Fax Number	:

Provider Business Practice Location Address
First Line	:	3851 S UPPER MEADOW CIRCLE
Second Line	:
City	:	WASILLA
State	:	AK
Zip	:	99623-9962
Country	:	US
Telephone Number	:	907-978-1343
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2019
Last Update Date	:	04/08/2019

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