MEDICARE: MRS. CORTNEY AUSTIN MACTAGGART 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-82469	NE

General Provider Information

NPI Number	:	1326411091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CORTNEY AUSTIN MACTAGGART IBCLC

Provider Business Mailing Address
First Line	:	2802 ARROWHEAD LN
Second Line	:
City	:	BELLEVUE
State	:	NE
Zip	:	68123-4612
Country	:	US
Telephone Number	:	402-515-7886
Fax Number	:

Provider Business Practice Location Address
First Line	:	2802 ARROWHEAD LN
Second Line	:
City	:	BELLEVUE
State	:	NE
Zip	:	68123-4612
Country	:	US
Telephone Number	:	402-515-7886
Fax Number	:

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

Provider Enumeration Date	:	11/03/2015
Last Update Date	:	11/03/2015

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