Healthcare Provider Details

I. General information

NPI: 1548084288
Provider Name (Legal Business Name): GOOD LIFE LACTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2024
Last Update Date: 11/11/2024
Certification Date: 11/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7398 W 162ND TER
OVERLAND PARK KS
66085-8240
US

IV. Provider business mailing address

6614 GOODE DR
SHAWNEE KS
66216-2515
US

V. Phone/Fax

Practice location:
  • Phone: 402-690-1689
  • Fax:
Mailing address:
  • Phone: 913-662-3415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number
License Number State

VIII. Authorized Official

Name: NATASHA KAY MIZNER
Title or Position: CO-OWNER/LACTATION CONSULTANT
Credential: RN, BSN, IBCLC
Phone: 402-690-1689