MEDICARE: MRS. JANIS M WILBERT 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	174H00000X	Health Educator
2	174N00000X	Lactation Consultant (Non-RN)

General Provider Information

NPI Number	:	1659643906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JANIS M WILBERT IBCLC

Provider Business Mailing Address
First Line	:	7777 FOREST LN STE B300
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-2510
Country	:	US
Telephone Number	:	214-549-9312
Fax Number	:

Provider Business Practice Location Address
First Line	:	7777 FOREST LN STE B300
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-2510
Country	:	US
Telephone Number	:	214-549-9312
Fax Number	:

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

Provider Enumeration Date	:	02/02/2012
Last Update Date	:	03/22/2024

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