MEDICARE: HEATHER MCSHANE

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)

General Provider Information

NPI Number	:	1780516161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER MCSHANE

Provider Business Mailing Address
First Line	:	526 MAYNARD AVE NW UNIT 416
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49504-4797
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	526 MAYNARD AVE NW UNIT 416
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49504-4797
Country	:	US
Telephone Number	:	616-216-8196
Fax Number	:

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

Provider Enumeration Date	:	06/01/2026
Last Update Date	:	06/01/2026

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Directions to “ HEATHER MCSHANE ” Practice Location

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