Healthcare Provider Details

I. General information

NPI: 1912764259
Provider Name (Legal Business Name): EMILY WEGENER BSN, RN, IBCLC, CMSR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 03/04/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9509 N KENWOOD CT
KANSAS CITY MO
64155-3337
US

IV. Provider business mailing address

9509 N KENWOOD CT
KANSAS CITY MO
64155-3337
US

V. Phone/Fax

Practice location:
  • Phone: 816-863-6468
  • Fax:
Mailing address:
  • Phone: 816-863-6468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number2005022879
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: