Individual
REBECCA GRAVENOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
IBCLC
Contact information
Practice address
8077 BAPTIST CHURCH RD, MARDELA SPRINGS, MD 21837-2421
(443) 523-6373
(443) 354-1853
Mailing address
PO BOX 316, MARDELA SPRINGS, MD 21837-0316
(443) 523-6373
(443) 354-1853
Taxonomy
Speciality
Code
Description
License number
State
174N00000X
Lactation Consultant (Non-RN)
Primary
L-134914
MD
Other
Enumeration date
03/04/2020
Last updated
05/06/2020
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