Healthcare Provider Details

I. General information

NPI: 1881430684
Provider Name (Legal Business Name): OLIVIA M MORAN CPM, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2024
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 AVENUE G
POWELL WY
82435-2216
US

IV. Provider business mailing address

518 COURT ST
CLIFTON FORGE VA
24422-1125
US

V. Phone/Fax

Practice location:
  • Phone: 307-281-6060
  • Fax:
Mailing address:
  • Phone: 307-281-6060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-314895
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: