MEDICARE: PATRICIA HANNING 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-11398	FL
2	163W00000X	Registered Nurse	RN9316706	FL

General Provider Information

NPI Number	:	1053799387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA HANNING IBCLC

Provider Business Mailing Address
First Line	:	2906 TRINITY COTTAGE DR
Second Line	:
City	:	LAND O LAKES
State	:	FL
Zip	:	34638-8134
Country	:	US
Telephone Number	:	813-505-6491
Fax Number	:

Provider Business Practice Location Address
First Line	:	2906 TRINITY COTTAGE DR
Second Line	:
City	:	LAND O LAKES
State	:	FL
Zip	:	34638-8134
Country	:	US
Telephone Number	:	813-505-6491
Fax Number	:

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

Provider Enumeration Date	:	05/06/2015
Last Update Date	:	10/05/2015

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