MEDICARE: MRS. CORRENE WERNER RN, BSN, IBCLC, RLC

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	163W00000X	Registered Nurse	599780-1	NY
2	163WL0100X	Lactation Consultant (Registered Nurse)	599780-1	NY

General Provider Information

NPI Number	:	1801077870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CORRENE WERNER RN, BSN, IBCLC, RLC

Provider Business Mailing Address
First Line	:	P.O. BOX 720831
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-4521
Country	:	US
Telephone Number	:	347-287-5278
Fax Number	:

Provider Business Practice Location Address
First Line	:	35-36 76TH STREET
Second Line	:	APARTMENT 509
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-4521
Country	:	US
Telephone Number	:	347-287-5278
Fax Number	:

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

Provider Enumeration Date	:	11/19/2007
Last Update Date	:	09/06/2015

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