MEDICARE: LUCIA GINES RN, 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)	168706	AZ

General Provider Information

NPI Number	:	1891484309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCIA GINES RN, IBCLC

Provider Business Mailing Address
First Line	:	1304 E MEADOWBROOK AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85014-4029
Country	:	US
Telephone Number	:	602-633-5302
Fax Number	:

Provider Business Practice Location Address
First Line	:	1304 E MEADOWBROOK AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85014-4029
Country	:	US
Telephone Number	:	602-633-5302
Fax Number	:

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

Provider Enumeration Date	:	05/02/2023
Last Update Date	:	05/02/2023

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