Healthcare Provider Details

I. General information

NPI: 1538832332
Provider Name (Legal Business Name): VANESSA WATSON RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2021
Last Update Date: 07/28/2021
Certification Date: 07/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7138 WOODLAND AVE
KANSAS CITY MO
64131-1848
US

IV. Provider business mailing address

7138 WOODLAND AVE
KANSAS CITY MO
64131-1848
US

V. Phone/Fax

Practice location:
  • Phone: 816-208-8593
  • Fax:
Mailing address:
  • Phone: 816-208-8593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number2013020787
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: