MEDICARE: MRS. JANET MARIE SYRCLE 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	163WL0100X	Lactation Consultant (Registered Nurse)	199-16053	TX

General Provider Information

NPI Number	:	1033353834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JANET MARIE SYRCLE IBCLC

Provider Business Mailing Address
First Line	:	8707 WOOD HOMESTEAD DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75249-4018
Country	:	US
Telephone Number	:	972-283-1836
Fax Number	:

Provider Business Practice Location Address
First Line	:	8707 WOOD HOMESTEAD DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75249-4018
Country	:	US
Telephone Number	:	972-283-1836
Fax Number	:

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

Provider Enumeration Date	:	04/23/2009
Last Update Date	:	04/23/2009

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