Individual provider · NPI-1

Maia Birchmoon-Gordon, RN, IBCLC

Registered Nurse, Lactation Consultant · Chicago, IL

NPI number1508663576
StatusActive
Last updated in NPPESFeb 27, 2025

Details

NPI
1508663576
Entity type
Individual (NPI-1)
Name
Maia Birchmoon-Gordon
Credential
RN, IBCLC
Sex
Female
Sole proprietor
No
Enumeration date
Feb 27, 2025
Certification date
Feb 24, 2025
Last updated
Feb 27, 2025

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
163WL0100X Registered Nurse, Lactation Consultant041-300200ILYes

Practice location

Outpatient Breastfeeding Clinic
5140 N California Ave Suite 420
Chicago, IL 60625

Phone 773-878-8200

Mailing address

7848 E Prairie Rd
Skokie, IL 60076-3672

Phone 773-710-6242

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