Healthcare Provider Details

I. General information

NPI: 1689454043
Provider Name (Legal Business Name): TAYLOR ESPINOSA BSN, RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2023
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4706 LAKE DAWNWOOD DR
JOHNSBURG IL
60051-7756
US

IV. Provider business mailing address

PO BOX 247
RINGWOOD IL
60072-0247
US

V. Phone/Fax

Practice location:
  • Phone: 815-427-1133
  • Fax:
Mailing address:
  • Phone: 815-427-1133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number041408259
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: