MEDICARE: MS. DIANE S MICHEL MSPH, IBCLC, RLC

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)	108-66501	CO

General Provider Information

NPI Number	:	1083949705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DIANE S MICHEL MSPH, IBCLC, RLC

Provider Business Mailing Address
First Line	:	5233 LAUREL AVE
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80303-2847
Country	:	US
Telephone Number	:	303-587-3326
Fax Number	:

Provider Business Practice Location Address
First Line	:	5233 LAUREL AVE
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80303-2847
Country	:	US
Telephone Number	:	303-587-3326
Fax Number	:

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

Provider Enumeration Date	:	10/14/2009
Last Update Date	:	09/04/2012

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