MEDICARE: LAURA HIGHTOWER 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)	L-45570	CA

General Provider Information

NPI Number	:	1447664024
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAURA HIGHTOWER RN IBCLC

Provider Business Mailing Address
First Line	:	1900 WASHINGTON ST
Second Line	:	102
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94109-2958
Country	:	US
Telephone Number	:	303-478-4884
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 WASHINGTON ST
Second Line	:	102
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94109-2958
Country	:	US
Telephone Number	:	303-478-4884
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER
Name	:	LAURA ROSE HIGHTOWER
Credential	:	RN IBCLC
Telephone Number	:	303-478-4884

Provider Enumeration Date	:	06/11/2014
Last Update Date	:	11/13/2014

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