MEDICARE: EMILY WEGENER BSN, RN, IBCLC, CMSR

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	163WL0100X	Lactation Consultant (Registered Nurse)	2005022879	MO

General Provider Information

NPI Number	:	1912764259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY WEGENER BSN, RN, IBCLC, CMSR

Provider Business Mailing Address
First Line	:	9509 N KENWOOD CT
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64155-3337
Country	:	US
Telephone Number	:	816-863-6468
Fax Number	:

Provider Business Practice Location Address
First Line	:	9509 N KENWOOD CT
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64155-3337
Country	:	US
Telephone Number	:	816-863-6468
Fax Number	:

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

Provider Enumeration Date	:	03/04/2024
Last Update Date	:	03/04/2024

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