MEDICARE: MRS. TANGELA LYNN BOYD 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	174N00000X	Lactation Consultant (Non-RN)	11084489	AL
2	374J00000X	Doula

General Provider Information

NPI Number	:	1760775423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TANGELA LYNN BOYD IBCLC

Provider Business Mailing Address
First Line	:	10429 DUNCANNON TRL
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-1200
Country	:	US
Telephone Number	:	334-593-5562
Fax Number	:	334-593-5041

Provider Business Practice Location Address
First Line	:	10429 DUNCANNON TRL
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-1200
Country	:	US
Telephone Number	:	334-593-5562
Fax Number	:	334-593-5041

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

Provider Enumeration Date	:	05/26/2011
Last Update Date	:	05/26/2011

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