MEDICARE: HANNAH AMELIA HALLIWELL 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-149790	CA

General Provider Information

NPI Number	:	1891395927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNAH AMELIA HALLIWELL IBCLC

Provider Business Mailing Address
First Line	:	1510 E WINDSOR RD
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91205-2724
Country	:	US
Telephone Number	:	310-403-0774
Fax Number	:

Provider Business Practice Location Address
First Line	:	1510 E WINDSOR RD
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91205-2724
Country	:	US
Telephone Number	:	310-403-0774
Fax Number	:

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

Provider Enumeration Date	:	10/28/2020
Last Update Date	:	10/28/2020

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