MEDICARE: MRS. SHANNON HELTON BAKER 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)	11014320	NC

General Provider Information

NPI Number	:	1821431255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHANNON HELTON BAKER IBCLC

Provider Business Mailing Address
First Line	:	6324 FAIRVIEW RD STE 435
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28210-3373
Country	:	US
Telephone Number	:	980-302-8835
Fax Number	:

Provider Business Practice Location Address
First Line	:	6324 FAIRVIEW RD STE 435
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28210-3373
Country	:	US
Telephone Number	:	980-302-8835
Fax Number	:

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

Provider Enumeration Date	:	04/16/2013
Last Update Date	:	08/15/2022

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