MEDICARE: ELENA MARIE JAWORSKI BSN, 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-157594	PA

General Provider Information

NPI Number	:	1457983447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELENA MARIE JAWORSKI BSN, RN, IBCLC

Provider Business Mailing Address
First Line	:	2617 S BANCROFT ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19145-4517
Country	:	US
Telephone Number	:	267-997-8958
Fax Number	:

Provider Business Practice Location Address
First Line	:	2617 S BANCROFT ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19145-4517
Country	:	US
Telephone Number	:	267-997-8958
Fax Number	:

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

Provider Enumeration Date	:	02/07/2020
Last Update Date	:	02/07/2020

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