Healthcare Provider Details

I. General information

NPI: 1841810546
Provider Name (Legal Business Name): KRISTAN NICHOLE ZYLKA BSN, RNC-OC, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2020
Last Update Date: 04/22/2020
Certification Date: 04/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

253 BELL RD
WESTMINSTER MD
21158-4107
US

IV. Provider business mailing address

253 BELL RD
WESTMINSTER MD
21158-4107
US

V. Phone/Fax

Practice location:
  • Phone: 410-274-6087
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberR165156
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: