MEDICARE: CYDNI OREBAUGH

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)	RN221259	GA

General Provider Information

NPI Number	:	1629701826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYDNI OREBAUGH

Provider Business Mailing Address
First Line	:	203 RUSHMORE WAY
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30114-4333
Country	:	US
Telephone Number	:	770-364-6302
Fax Number	:

Provider Business Practice Location Address
First Line	:	2141 KINGSTON CT SE STE 103
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30067-8928
Country	:	US
Telephone Number	:	770-644-0555
Fax Number	:

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

Provider Enumeration Date	:	07/05/2022
Last Update Date	:	07/05/2022

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