MEDICARE: MRS. HEATHER BRINN CONWAY ICCE, 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	174400000X	Specialist

General Provider Information

NPI Number	:	1700019825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HEATHER BRINN CONWAY ICCE, IBCLC

Provider Business Mailing Address
First Line	:	8623 CLIFFWOOD WAY
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95826-3612
Country	:	US
Telephone Number	:	916-261-5683
Fax Number	:

Provider Business Practice Location Address
First Line	:	8623 CLIFFWOOD WAY
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95826-3612
Country	:	US
Telephone Number	:	916-261-5683
Fax Number	:

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

Provider Enumeration Date	:	08/24/2009
Last Update Date	:	08/24/2009

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