Healthcare Provider Details

I. General information

NPI: 1245069715
Provider Name (Legal Business Name): JANE KLEMEN RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2024
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 LEE RD STE 107
WINTER PARK FL
32789-1847
US

IV. Provider business mailing address

1950 LEE RD STE 107
WINTER PARK FL
32789-1847
US

V. Phone/Fax

Practice location:
  • Phone: 407-203-9593
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRN9454436
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: