MEDICARE: BETHANY MCGOWAN RN, 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)	R919225	MD

General Provider Information

NPI Number	:	1114880143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETHANY MCGOWAN RN, IBCLC

Provider Business Mailing Address
First Line	:	1718 ABERDEEN CIR
Second Line	:
City	:	CROFTON
State	:	MD
Zip	:	21114-1618
Country	:	US
Telephone Number	:	443-292-2412
Fax Number	:

Provider Business Practice Location Address
First Line	:	1718 ABERDEEN CIR
Second Line	:
City	:	CROFTON
State	:	MD
Zip	:	21114-1618
Country	:	US
Telephone Number	:	443-292-2412
Fax Number	:

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

Provider Enumeration Date	:	12/05/2025
Last Update Date	:	01/25/2026

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