Rebecca Gravenor, IBCLC

Primary specialty

Lactation Consultant (Non-RN)Taxonomy code 174N00000X

License

L-134914 Issued in MD

Practice address

8077 Baptist Church Rd
Mardela Springs, MD 21837-2421

Phone

(443) 523-6373

Fax

(443) 354-1853

NPI assigned

Mar 4, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• The Village Lactation

  • Lactation Consultant (Non-RN)
  • Mardela Springs, MD
  • NPI 1790653251

  Lactation Consultant, Non-RN

  NPD Authorized official

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

{
    "created_epoch": "1583280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588723200000",
    "number": "1356976906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 316",
            "city": "MARDELA SPRINGS",
            "state": "MD",
            "postal_code": "218370316",
            "telephone_number": "443-523-6373",
            "fax_number": "443-354-1853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8077 BAPTIST CHURCH RD",
            "city": "MARDELA SPRINGS",
            "state": "MD",
            "postal_code": "218372421",
            "telephone_number": "443-523-6373",
            "fax_number": "443-354-1853"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2324 N Zion Rd Ste 111",
            "address_purpose": "LOCATION",
            "city": "Salisbury",
            "state": "MD",
            "postal_code": "218012574",
            "country_code": "US",
            "telephone_number": "443-944-8891",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRAVENOR",
        "first_name": "REBECCA",
        "credential": "IBCLC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-04",
        "last_updated": "2020-05-06",
        "certification_date": "2020-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174N00000X",
            "taxonomy_group": "",
            "desc": "Lactation Consultant, Non-RN",
            "state": "MD",
            "license": "L-134914",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas James Corbett
• Vernon Deshields
• Angela L Ford, LCSW-C
• Joy Gibson-McIntire, LCPC
• Colton Hunter Goins, LMSW
• Abigail Hansen
• Jessica Dawn Holloway-Hill, LCSW-C
• Toni Huffman, LGSW
• Ashley Jester, LMSW
• Julie Johnson, LGSW

• Lactation Consultant (Non-RN) in Mardela Springs, MD
• Providers in Mardela Springs, MD by specialty
• Lactation Consultant (Non-RN) in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2020; 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.