Healthcare Provider Details

I. General information

NPI: 1255216115
Provider Name (Legal Business Name): ROBIN MACKENZIE GRAUMENZ RN, BSN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2025
Last Update Date: 08/09/2025
Certification Date: 08/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19188 PEMBROOK
MARTHASVILLE MO
63357-2647
US

IV. Provider business mailing address

19188 PEMBROOK
MARTHASVILLE MO
63357-2647
US

V. Phone/Fax

Practice location:
  • Phone: 618-267-5898
  • Fax: 618-267-5898
Mailing address:
  • Phone: 618-267-5898
  • Fax: 618-267-5898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number2012036896
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: