Provider Demographics
NPI:1295545143
Name:LEBANO, TIFFANY (RN IBCLC)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:LEBANO
Suffix:
Gender:F
Credentials:RN IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6702 WHITEGATE RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-1620
Mailing Address - Country:US
Mailing Address - Phone:240-440-1924
Mailing Address - Fax:
Practice Address - Street 1:6702 WHITEGATE RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21029-1620
Practice Address - Country:US
Practice Address - Phone:240-440-1924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR212848163WM0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn