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NPI Code Detail

MEDICARE: TERESA MCCORMACK LACTATION SUPPORT LLC

MEDICARE: TERESA MCCORMACK LACTATION SUPPORT LLC
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
1163WL0100XLactation Consultant (Registered Nurse)

General Provider Information

NPI Number : 1861950545
Entity Type Code : Organization
Provider Name (Legal Business Name) : TERESA MCCORMACK LACTATION SUPPORT LLC
Provider Business Mailing Address
First Line : 9728 MARILLA DR UNIT 205
Second Line :
City : LAKESIDE
State : CA
Zip : 92040-2853
Country : US
Telephone Number : 858-216-6257
Fax Number :
Provider Business Practice Location Address
First Line : 4443 30TH ST STE 205
Second Line :
City : SAN DIEGO
State : CA
Zip : 92116-4291
Country : US
Telephone Number : 619-567-8146
Fax Number :
Authorized Official
Title or Position : MANAGING MEMBER
Name : TERESA ANN MCCORMACK
Credential : RN, IBCLC
Telephone Number : 858-216-6257
Provider Enumeration Date : 03/12/2019
Last Update Date : 03/12/2019

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Directions to “TERESA MCCORMACK LACTATION SUPPORT LLC ” Practice Location

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