Healthcare Provider Details

I. General information

NPI: 1255565636
Provider Name (Legal Business Name): ELIZABETH L SCHIRK RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2009
Last Update Date: 05/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 GILLHAM RD
KANSAS CITY MO
64108-4619
US

IV. Provider business mailing address

11500 N EWING AVE
KANSAS CITY MO
64156-7914
US

V. Phone/Fax

Practice location:
  • Phone: 816-234-3468
  • Fax:
Mailing address:
  • Phone: 816-739-0828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number2003028625
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: