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General NPI Number Information
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NPI Number | 1275323602
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Entity Type | Individual
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Provider Name | LISA KAY MAIZE IBCLC
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Gender | Female
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Dates
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Enumeration Date | 05/08/2025
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Last Update Date | 05/08/2025
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Provider Practice Location Address
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Address Line | 24894 RAVINE CT # 2204
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City | FARMINGTON HILLS
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State | MI
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Zip | 48335-2432
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Country | US
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Telephone | 407-791-3455
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Fax |
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Provider Business Mailing Address
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Address Line | 24894 RAVINE CT # 2204
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City | FARMINGTON HILLS
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State | MI
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Zip | 48335-2432
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Country | US
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Telephone | 407-791-3455
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174N00000X
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Taxonomy Name | Lactation Consultant (Non-RN)
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License Number | L-145779
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License Number State | FL
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