MEDICARE: JENNIFER PRAZAK RNC-OB, 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-311663	IL

General Provider Information

NPI Number	:	1497532485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER PRAZAK RNC-OB, IBCLC

Provider Business Mailing Address
First Line	:	1233 N HOYNE AVE APT 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-2503
Country	:	US
Telephone Number	:	630-453-7651
Fax Number	:

Provider Business Practice Location Address
First Line	:	1931 W BELMONT AVE APT 3E
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-7199
Country	:	US
Telephone Number	:	630-453-7651
Fax Number	:

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

Provider Enumeration Date	:	09/12/2023
Last Update Date	:	09/12/2023

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