Provider Demographics
NPI:1902152804
Name:SANDERS, MICHELLE (MS, IBCLC, LLLL)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:SANDERS
Suffix:
Gender:F
Credentials:MS, IBCLC, LLLL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9527 KESSLER ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-5056
Mailing Address - Country:US
Mailing Address - Phone:913-231-3834
Mailing Address - Fax:
Practice Address - Street 1:9527 KESSLER ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-5056
Practice Address - Country:US
Practice Address - Phone:913-231-3834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-28
Last Update Date:2012-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11154235174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN