Healthcare Provider Details

I. General information

NPI: 1194563643
Provider Name (Legal Business Name): AGNES SCHAFFER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2024
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9280 W SUNSET RD STE 400
LAS VEGAS NV
89148-4862
US

IV. Provider business mailing address

11925 LUNA DEL MAR LN
LAS VEGAS NV
89138-4526
US

V. Phone/Fax

Practice location:
  • Phone: 725-900-8613
  • Fax:
Mailing address:
  • Phone: 815-342-9154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. AGNES SCHAFFER
Title or Position: RN LACTATION CONSULTANT
Credential: BSN, RN, IBCLC
Phone: 815-342-9154