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General NPI Number Information
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NPI Number | 1073729091
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Entity Type | Individual
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Provider Name | MARY ANN BAUL IBCLC, RN
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Gender | Female
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 1200 N BEAVER ST
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-3118
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Country | US
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Telephone | 928-214-2605
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Fax | 928-214-2892
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Provider Business Mailing Address
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Address Line | 1200 N. BEAVER STREET PAYER CREDENTIALING
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City | FLAGSTAFF
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State | AZ
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Zip | 86001
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Country | US
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Telephone | 928-213-9235
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Fax | 928-213-6292
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WL0100X
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Taxonomy Name | Lactation Consultant (Registered Nurse)
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License Number | L-86798
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number | LM069
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License Number State | AZ
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