Healthcare Provider Details

I. General information

NPI: 1578381679
Provider Name (Legal Business Name): LINDA LANGNESS RN, BSN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 09/30/2024
Certification Date: 09/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 WESTRIDGE DR
COLUMBIA MO
65203-1762
US

IV. Provider business mailing address

512 WESTRIDGE DR
COLUMBIA MO
65203-1762
US

V. Phone/Fax

Practice location:
  • Phone: 573-529-9781
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2014016168
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-143915
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: