MEDICARE: SANDRA LEMKE 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	174N00000X	Lactation Consultant (Non-RN)	10973294	TX

General Provider Information

NPI Number	:	1558794834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA LEMKE IBCLC

Provider Business Mailing Address
First Line	:	4002 ABERDEEN WAY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77025-2306
Country	:	US
Telephone Number	:	713-927-3384
Fax Number	:

Provider Business Practice Location Address
First Line	:	4002 ABERDEEN WAY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77025-2306
Country	:	US
Telephone Number	:	713-927-3384
Fax Number	:

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

Provider Enumeration Date	:	08/09/2013
Last Update Date	:	08/09/2013

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