Healthcare Provider Details

I. General information

NPI: 1235903246
Provider Name (Legal Business Name): KAYLAH ANDERSON RN, BSN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2023
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 9TH ST SE STE 1
ROCHESTER MN
55904-6400
US

IV. Provider business mailing address

1655 GRAY FOX DR NE
OWATONNA MN
55060-3983
US

V. Phone/Fax

Practice location:
  • Phone: 507-288-3443
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number236512-8
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-308294
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: