MEDICARE: TAYA KANGISER 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)

General Provider Information

NPI Number	:	1356205785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYA KANGISER IBCLC

Provider Business Mailing Address
First Line	:	5930 S 58TH ST STE W
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68516-3653
Country	:	US
Telephone Number	:	402-423-6402
Fax Number	:	402-423-6422

Provider Business Practice Location Address
First Line	:	10818 ELM ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68144-4820
Country	:	US
Telephone Number	:	402-502-0617
Fax Number	:	402-502-4676

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

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	12/10/2025

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