Healthcare Provider Details

I. General information

NPI: 1699240002
Provider Name (Legal Business Name): JENNIFER MAEDER RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2018
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3841 24TH ST STE 5
SAN FRANCISCO CA
94114-3810
US

IV. Provider business mailing address

4152 23RD ST
SAN FRANCISCO CA
94114-3220
US

V. Phone/Fax

Practice location:
  • Phone: 415-531-0934
  • Fax:
Mailing address:
  • Phone: 415-531-0934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number706067
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-143286
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: