Healthcare Provider Details

I. General information

NPI: 1063291342
Provider Name (Legal Business Name): ROBIN ZANCHETTA RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2023
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 MEADOW RD
BALTIMORE MD
21206-2106
US

IV. Provider business mailing address

410 MEADOW RD
BALTIMORE MD
21206-2106
US

V. Phone/Fax

Practice location:
  • Phone: 410-818-7404
  • Fax:
Mailing address:
  • Phone: 410-818-7404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-50263
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: