Healthcare Provider Details

I. General information

NPI: 1164326229
Provider Name (Legal Business Name): ALI MARIE LEBHAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 GREAT LAKE DR
ANNAPOLIS MD
21403-3725
US

IV. Provider business mailing address

84 GREAT LAKE DR
ANNAPOLIS MD
21403-3725
US

V. Phone/Fax

Practice location:
  • Phone: 904-307-2004
  • Fax:
Mailing address:
  • Phone: 904-307-2004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number849634
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-322857
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: