Healthcare Provider Details

I. General information

NPI: 1124703376
Provider Name (Legal Business Name): EMILY ANN ANDERSON RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2023
Last Update Date: 06/17/2023
Certification Date: 06/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

672 SE BAYBERRY LN STE 101
LEES SUMMIT MO
64063-4262
US

IV. Provider business mailing address

10336 WALMER ST
OVERLAND PARK KS
66212-1741
US

V. Phone/Fax

Practice location:
  • Phone: 816-281-7558
  • Fax:
Mailing address:
  • Phone: 785-456-4492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-311920
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: