Healthcare Provider Details

I. General information

NPI: 1487374369
Provider Name (Legal Business Name): MOLLY PFEIFER BSN, RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2022
Last Update Date: 08/31/2022
Certification Date: 08/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8069 N 129TH AVE
OMAHA NE
68142-1808
US

IV. Provider business mailing address

8069 N 129TH AVE
OMAHA NE
68142-1808
US

V. Phone/Fax

Practice location:
  • Phone: 952-807-8626
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number85344
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: