MEDICARE: MRS. HALEY LAUREN GONZALES RN, BSN, 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	163W00000X	Registered Nurse	255580	NC
2	163WL0100X	Lactation Consultant (Registered Nurse)	L-310829	MO

General Provider Information

NPI Number	:	1205349511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HALEY LAUREN GONZALES RN, BSN, IBCLC

Provider Business Mailing Address
First Line	:	1413 PLEASANT HILL DR
Second Line	:
City	:	PLATTE CITY
State	:	MO
Zip	:	64079-7631
Country	:	US
Telephone Number	:	704-451-0410
Fax Number	:

Provider Business Practice Location Address
First Line	:	1413 PLEASANT HILL DR
Second Line	:
City	:	PLATTE CITY
State	:	MO
Zip	:	64079-7631
Country	:	US
Telephone Number	:	704-451-0410
Fax Number	:

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

Provider Enumeration Date	:	11/08/2017
Last Update Date	:	06/22/2023

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