Healthcare Provider Details

I. General information

NPI: 1922575919
Provider Name (Legal Business Name): HEATHER JO HOBBS IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS HEATHER JO FLOWERS

II. Dates (important events)

Enumeration Date: 10/27/2018
Last Update Date: 10/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10630 LITTLE PATUXENT PKWY STE 128
COLUMBIA MD
21044-6233
US

IV. Provider business mailing address

10630 LITTLE PATUXENT PKWY STE 128
COLUMBIA MD
21044-6233
US

V. Phone/Fax

Practice location:
  • Phone: 301-928-4952
  • Fax:
Mailing address:
  • Phone: 301-928-4952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-49790
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: