Healthcare Provider Details

I. General information

NPI: 1942446323
Provider Name (Legal Business Name): MICHELLE LEE JANYSKA RN,BSN,IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2009
Last Update Date: 01/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 SKYGROVE DR
HOLLY SPRINGS NC
27540-9459
US

IV. Provider business mailing address

208 SKYGROVE DRIVE
HOLLY SPRINGS NC
27540-9459
US

V. Phone/Fax

Practice location:
  • Phone: 919-830-4188
  • Fax:
Mailing address:
  • Phone: 919-830-4188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number206140
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number107-26120
License Number StateZZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: