MEDICARE: CAROLYNN ELAINE CONTI IBCLC, RN

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)	201404525RN	OR

General Provider Information

NPI Number	:	1316410129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYNN ELAINE CONTI IBCLC, RN

Provider Business Mailing Address
First Line	:	4036 S 6TH ST STE 2
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97603-4750
Country	:	US
Telephone Number	:	208-573-1147
Fax Number	:

Provider Business Practice Location Address
First Line	:	4036 S 6TH ST
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97603-4750
Country	:	US
Telephone Number	:	208-573-1147
Fax Number	:

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

Provider Enumeration Date	:	01/03/2019
Last Update Date	:	01/24/2019

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