Healthcare Provider Details

I. General information

NPI: 1225854029
Provider Name (Legal Business Name): KAYLEE MARIE METZLER RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2024
Last Update Date: 11/26/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 CLARKSBURG RD
CLARKSBURG PA
15725-8128
US

IV. Provider business mailing address

60 CLARKSBURG RD
CLARKSBURG PA
15725-8128
US

V. Phone/Fax

Practice location:
  • Phone: 724-388-4913
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRN719155
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: