MEDICARE: RONISHA LESHAE CONWAY IBCLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174N00000X	Lactation Consultant (Non-RN)	L-305877

General Provider Information

NPI Number	:	1134889397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONISHA LESHAE CONWAY IBCLC

Provider Business Mailing Address
First Line	:	6638 COLLEGE AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64132-1202
Country	:	US
Telephone Number	:	816-785-1029
Fax Number	:

Provider Business Practice Location Address
First Line	:	6638 COLLEGE AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64132-1202
Country	:	US
Telephone Number	:	816-785-1029
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2021
Last Update Date	:	12/29/2021

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