Healthcare Provider Details

I. General information

NPI: 1144092180
Provider Name (Legal Business Name): JAMIE MALYN RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2023
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 BURKE AVE
TOWSON MD
21286-1119
US

IV. Provider business mailing address

112 BURKE AVE
TOWSON MD
21286-1119
US

V. Phone/Fax

Practice location:
  • Phone: 410-929-4616
  • Fax:
Mailing address:
  • Phone: 410-929-4616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberR-187533
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: