MEDICARE: RACHEL MARIANNE MOSOLF RN, BSN, 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	163WL0100X	Lactation Consultant (Registered Nurse)	L-303629	CA
2	374J00000X	Doula

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	95158835	OTHER	CA	RN
2	L-303629	OTHER	CA	IBCLE

General Provider Information

NPI Number	:	1558958140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL MARIANNE MOSOLF RN, BSN, IBCLC

Provider Business Mailing Address
First Line	:	3440 BOSTON AVE
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94602-2906
Country	:	US
Telephone Number	:	831-901-4987
Fax Number	:

Provider Business Practice Location Address
First Line	:	3440 BOSTON AVE
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94602-2906
Country	:	US
Telephone Number	:	831-901-4987
Fax Number	:

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

Provider Enumeration Date	:	12/29/2020
Last Update Date	:	09/02/2024

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