MEDICARE: JULIA FULLER KLING CBC

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)

General Provider Information

NPI Number	:	1598303513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIA FULLER KLING CBC

Provider Business Mailing Address
First Line	:	1497 CARROLL ST APT 49
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11213-4580
Country	:	US
Telephone Number	:	845-664-2301
Fax Number	:

Provider Business Practice Location Address
First Line	:	1497 CARROLL ST APT 49
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11213-4580
Country	:	US
Telephone Number	:	845-664-2301
Fax Number	:

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

Provider Enumeration Date	:	12/20/2019
Last Update Date	:	12/20/2019

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