Healthcare Provider Details

I. General information

NPI: 1407612989
Provider Name (Legal Business Name): LAURYNN KNERR RN IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2024
Last Update Date: 02/22/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13802 N 32ND ST STE 8
PHOENIX AZ
85032-5638
US

IV. Provider business mailing address

2257 E QUESTA DR
PHOENIX AZ
85024-5315
US

V. Phone/Fax

Practice location:
  • Phone: 815-666-6775
  • Fax:
Mailing address:
  • Phone: 815-666-6775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-312475
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: