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NPI Code Detail

MEDICARE: HAILEY JUSTL RN, IBCLC

MEDICARE: HAILEY JUSTL 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
1163WL0100XLactation Consultant (Registered Nurse)L-312536AZ

General Provider Information

NPI Number : 1619732278
Entity Type Code : Individual
Provider Name (Legal Business Name) : HAILEY JUSTL RN, IBCLC
Provider Business Mailing Address
First Line : 3406 W DUNBAR DR
Second Line :
City : PHOENIX
State : AZ
Zip : 85041-6771
Country : US
Telephone Number : 623-670-0071
Fax Number :
Provider Business Practice Location Address
First Line : 13802 N 32ND ST STE 8
Second Line :
City : PHOENIX
State : AZ
Zip : 85032-5638
Country : US
Telephone Number : 623-670-0071
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2024
Last Update Date : 02/13/2024

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