MEDICARE: YOUR LACTATION NURSE INC.

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)

General Provider Information

NPI Number	:	1316723307
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUR LACTATION NURSE INC.

Provider Business Mailing Address
First Line	:	8202 SEENO AVE
Second Line	:
City	:	GRANITE BAY
State	:	CA
Zip	:	95746-6044
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8202 SEENO AVE
Second Line	:
City	:	GRANITE BAY
State	:	CA
Zip	:	95746-6044
Country	:	US
Telephone Number	:	916-234-6380
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MS. BRANDEE GUTOWSKY
Credential	:	RN, IBCLC
Telephone Number	:	562-665-0185

Provider Enumeration Date	:	09/05/2023
Last Update Date	:	09/05/2023

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