Healthcare Provider Details

I. General information

NPI: 1083591788
Provider Name (Legal Business Name): EMILY K MUNRO NGO RN, PHN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2025
Last Update Date: 08/18/2025
Certification Date: 08/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1127 E DEL MAR BLVD APT 424
PASADENA CA
91106-3486
US

IV. Provider business mailing address

1127 E DEL MAR BLVD APT 424
PASADENA CA
91106-3486
US

V. Phone/Fax

Practice location:
  • Phone: 916-479-2379
  • Fax:
Mailing address:
  • Phone: 916-479-2379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number95026120
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-301541
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: