MEDICARE: TARA CZAPLA IBCLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174N00000X	Lactation Consultant (Non-RN)	L-148668	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	L-148668	OTHER		IBLCE

General Provider Information

NPI Number	:	1023892650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA CZAPLA IBCLC

Provider Business Mailing Address
First Line	:	935 N CIMMARON ST
Second Line	:
City	:	POST FALLS
State	:	ID
Zip	:	83854-6047
Country	:	US
Telephone Number	:	208-518-8581
Fax Number	:

Provider Business Practice Location Address
First Line	:	1621 W CARROLL AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-2501
Country	:	US
Telephone Number	:	208-777-6455
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2023
Last Update Date	:	08/23/2023

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