=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649099433
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RACHEL ELENA BELSKUS IBCLC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/08/2024
-----------------------------------------------------
Last Update Date | 10/08/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5995 N 78TH ST UNIT 2096
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85250-6151
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-466-4386
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14757 N 90TH PL
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85260-2701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-466-4386
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174N00000X
-----------------------------------------------------
Taxonomy Name | Lactation Consultant (Non-RN)
-----------------------------------------------------
License Number | L-315757
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------