Healthcare Provider Details

I. General information

NPI: 1669111324
Provider Name (Legal Business Name): ANGELA SCALISE RN IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2022
Last Update Date: 06/01/2022
Certification Date: 06/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15184 MONROVIA ST
OVERLAND PARK KS
66221-2366
US

IV. Provider business mailing address

15184 MONROVIA ST
OVERLAND PARK KS
66221-2366
US

V. Phone/Fax

Practice location:
  • Phone: 913-205-7292
  • Fax:
Mailing address:
  • Phone: 913-205-7292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number14-151768-111
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: