Individual provider Active NPI

Tanya Powell, BA, CLE, IBCLC

  • Lactation Consultant (Non-RN)
  • San Rafael, CA
National Provider Identifier
1265837645
Registry record updated Oct 28, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Lactation Consultant (Non-RN)Taxonomy code 174N00000X
License
IBCLC #L-57367
Practice address
4460 Redwood Hwy Ste 16-379
San Rafael, CA 94903-1951
Phone
(415) 302-4354
NPI assigned
Oct 28, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 28, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Lactation Consultant (Non-RN) 174N00000X IBCLC #L-57367 Primary

Addresses

Primary practice location

4460 Redwood Hwy Ste 16-379
San Rafael, CA 94903-1951

Mailing address

4460 Redwood Hwy Ste 16-379
San Rafael, CA 94903-1951
Phone (415) 302-4354

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Bachelor of Arts

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1414454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1414454400000",
    "number": "1265837645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4460 REDWOOD HWY STE 16-379",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949031951",
            "telephone_number": "415-302-4354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4460 REDWOOD HWY STE 16-379",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949031951",
            "telephone_number": "415-302-4354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POWELL",
        "first_name": "TANYA",
        "name_prefix": "Mrs.",
        "credential": "BA, CLE, IBCLC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-10-28",
        "last_updated": "2014-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174N00000X",
            "taxonomy_group": "",
            "desc": "Lactation Consultant, Non-RN",
            "state": null,
            "license": "IBCLC #L-57367",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Rafael, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.