MEDICARE: ROSALIE KMIEC R.N., I.B.C.L.C

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)	RN598556	PA

General Provider Information

NPI Number	:	1225455710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSALIE KMIEC R.N., I.B.C.L.C

Provider Business Mailing Address
First Line	:	1912 WEBSTER ST
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19146-1828
Country	:	US
Telephone Number	:	610-322-4932
Fax Number	:

Provider Business Practice Location Address
First Line	:	1912 WEBSTER ST
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19146-1828
Country	:	US
Telephone Number	:	610-322-4932
Fax Number	:

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

Provider Enumeration Date	:	03/24/2014
Last Update Date	:	03/24/2014

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Directions to “ ROSALIE KMIEC R.N., I.B.C.L.C” Practice Location

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