MEDICARE: MRS. KIMBERLY MARIE CRUSER BSN, 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)	L-134904	PA

General Provider Information

NPI Number	:	1932978244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY MARIE CRUSER BSN, IBCLC

Provider Business Mailing Address
First Line	:	2553 BALTIMORE PIKE
Second Line	:
City	:	OXFORD
State	:	PA
Zip	:	19363-3926
Country	:	US
Telephone Number	:	610-563-7285
Fax Number	:

Provider Business Practice Location Address
First Line	:	2553 BALTIMORE PIKE
Second Line	:
City	:	OXFORD
State	:	PA
Zip	:	19363-3926
Country	:	US
Telephone Number	:	610-563-7285
Fax Number	:

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

Provider Enumeration Date	:	12/28/2023
Last Update Date	:	12/28/2023

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