MEDICARE: AMY TAYLOR RN, CBS, 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)	0001181317	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	L-302768	OTHER		IBCLC

General Provider Information

NPI Number	:	1467011510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY TAYLOR RN, CBS, IBCLC

Provider Business Mailing Address
First Line	:	4176 S PLAZA TRL STE 217
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-1920
Country	:	US
Telephone Number	:	757-642-4568
Fax Number	:	757-455-8055

Provider Business Practice Location Address
First Line	:	4176 S PLAZA TRL STE 217
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-1920
Country	:	US
Telephone Number	:	757-642-4568
Fax Number	:	757-455-8055

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

Provider Enumeration Date	:	06/12/2019
Last Update Date	:	04/23/2021

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