Healthcare Provider Details

I. General information

NPI: 1750731162
Provider Name (Legal Business Name): STACIA A KAUTZER BSN IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2016
Last Update Date: 06/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 4TH ST SE
ROCHESTER MN
55904-4717
US

IV. Provider business mailing address

8338 90TH ST NW
ORONOCO MN
55960-2168
US

V. Phone/Fax

Practice location:
  • Phone: 507-529-6750
  • Fax:
Mailing address:
  • Phone: 507-356-4524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberR 145799-5
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: