MEDICARE: SUSAN HOWARD RN, MSN, 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)	0001149765	VA

General Provider Information

NPI Number	:	1932473543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN HOWARD RN, MSN, IBCLC

Provider Business Mailing Address
First Line	:	6414 SHADY LN
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22042-2316
Country	:	US
Telephone Number	:	703-532-1254
Fax Number	:	703-532-1254

Provider Business Practice Location Address
First Line	:	6414 SHADY LN
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22042-2316
Country	:	US
Telephone Number	:	703-532-1254
Fax Number	:	703-532-1254

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

Provider Enumeration Date	:	02/28/2012
Last Update Date	:	02/28/2012

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