MEDICARE: MRS. SUSANNE ESTES 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
1	163WL0100X	Lactation Consultant (Registered Nurse)	L-303905	AZ
2	163WL0100X	Lactation Consultant (Registered Nurse)	RN198571	AZ

General Provider Information

NPI Number	:	1629857792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSANNE ESTES RN, IBCLC

Provider Business Mailing Address
First Line	:	3825 W BROGAN CT
Second Line	:
City	:	NEW RIVER
State	:	AZ
Zip	:	85087-6201
Country	:	US
Telephone Number	:	602-334-0811
Fax Number	:

Provider Business Practice Location Address
First Line	:	3825 W BROGAN CT
Second Line	:
City	:	NEW RIVER
State	:	AZ
Zip	:	85087-6201
Country	:	US
Telephone Number	:	602-334-0811
Fax Number	:

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

Provider Enumeration Date	:	09/27/2023
Last Update Date	:	09/27/2023

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