MEDICARE: MS. BRANDEE GUTOWSKY RN, 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	163WL0100X	Lactation Consultant (Registered Nurse)	843599	CA
2	163W00000X	Registered Nurse	843599	CA

General Provider Information

NPI Number	:	1841980778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BRANDEE GUTOWSKY RN, IBCLC

Provider Business Mailing Address
First Line	:	8202 SEENO AVE
Second Line	:
City	:	GRANITE BAY
State	:	CA
Zip	:	95746-6044
Country	:	US
Telephone Number	:	562-665-0185
Fax Number	:

Provider Business Practice Location Address
First Line	:	8202 SEENO AVE
Second Line	:
City	:	GRANITE BAY
State	:	CA
Zip	:	95746-6044
Country	:	US
Telephone Number	:	562-665-0185
Fax Number	:

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

Provider Enumeration Date	:	05/12/2023
Last Update Date	:	06/15/2023

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