MEDICARE: JEANNINE J. LEAPER 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)	A216216	CA

General Provider Information

NPI Number	:	1992999460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANNINE J. LEAPER RN, IBCLC

Provider Business Mailing Address
First Line	:	PO BOX 2117
Second Line	:
City	:	CAPISTRANO BEACH
State	:	CA
Zip	:	92624-0117
Country	:	US
Telephone Number	:	949-240-0530
Fax Number	:

Provider Business Practice Location Address
First Line	:	34232 VIA VELEZ
Second Line	:
City	:	CAPISTRANO BEACH
State	:	CA
Zip	:	92624-1308
Country	:	US
Telephone Number	:	949-240-0530
Fax Number	:

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

Provider Enumeration Date	:	08/28/2007
Last Update Date	:	08/28/2007

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