MEDICARE: TAMANA MAWARI 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-308280	MI

General Provider Information

NPI Number	:	1194520205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMANA MAWARI IBCLC

Provider Business Mailing Address
First Line	:	6120 PAYNE AVE
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48126-2089
Country	:	US
Telephone Number	:	313-428-2706
Fax Number	:

Provider Business Practice Location Address
First Line	:	6120 PAYNE AVE
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48126-2089
Country	:	US
Telephone Number	:	313-428-2706
Fax Number	:

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

Provider Enumeration Date	:	02/14/2025
Last Update Date	:	02/14/2025

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