Healthcare Provider Details

I. General information

NPI: 1114665353
Provider Name (Legal Business Name): NATASHA KAY MIZNER RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2022
Last Update Date: 05/26/2022
Certification Date: 05/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6614 GOODE DR
SHAWNEE KS
66216-2515
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: 402-690-1689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number136401
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: