=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295545143
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TIFFANY LEBANO RN IBCLC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2025
-----------------------------------------------------
Last Update Date | 06/16/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8115 MAPLE LAWN BLVD STE 350
-----------------------------------------------------
City | FULTON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20759-2683
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-440-1924
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8115 MAPLE LAWN BLVD STE 350
-----------------------------------------------------
City | FULTON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20759-2683
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-440-1924
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WL0100X
-----------------------------------------------------
Taxonomy Name | Lactation Consultant (Registered Nurse)
-----------------------------------------------------
License Number | L-316884
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163WM0102X
-----------------------------------------------------
Taxonomy Name | Maternal Newborn Registered Nurse
-----------------------------------------------------
License Number | R212848
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------