Healthcare Provider Details

I. General information

NPI: 1386409993
Provider Name (Legal Business Name): PATRICIA KEZAR RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PATRICIA ALLEN

II. Dates (important events)

Enumeration Date: 02/14/2024
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23A GATCHELL WAY
EPPING NH
03042-1920
US

IV. Provider business mailing address

23A GATCHELL WAY
EPPING NH
03042-1920
US

V. Phone/Fax

Practice location:
  • Phone: 603-475-4695
  • Fax:
Mailing address:
  • Phone: 603-475-4695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number087189-21
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: