Healthcare Provider Details

I. General information

NPI: 1134760671
Provider Name (Legal Business Name): THISTLEBIRD LACTATION CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2019
Last Update Date: 10/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8821 COLUMBIA 100 PARKWAY
COLUMBIA MD
21045
US

IV. Provider business mailing address

8821 COLUMBIA 100 PARKWAY
COLUMBIA MD
21045
US

V. Phone/Fax

Practice location:
  • Phone: 410-992-0511
  • Fax:
Mailing address:
  • Phone: 410-992-0511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: HOPE BIRD
Title or Position: PEDIATRIC NURSE PRACTITIONER, LACTA
Credential: CRNP, IBCLC
Phone: 410-992-0511