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NPI Code Detail

MEDICARE: MRS. GRACE NORTON RDN, IBCLC

MEDICARE: MRS. GRACE NORTON RDN, 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
1174N00000XLactation Consultant (Non-RN)L-61999AZ
2133V00000XRegistered Dietitian1049578AZ

General Provider Information

NPI Number : 1881137776
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. GRACE NORTON RDN, IBCLC
Provider Business Mailing Address
First Line : 9393 E PALO BREA BND APT 1097
Second Line :
City : SCOTTSDALE
State : AZ
Zip : 85255-6510
Country : US
Telephone Number : 480-416-7295
Fax Number :
Provider Business Practice Location Address
First Line : 4408 N 38TH ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85018-4114
Country : US
Telephone Number : 480-256-9105
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/23/2016
Last Update Date : 05/07/2021

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