Provider Demographics
NPI:1548084288
Name:GOOD LIFE LACTATION LLC
Entity type:Organization
Organization Name:GOOD LIFE LACTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/LACTATION CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:MIZNER
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, IBCLC
Authorized Official - Phone:402-690-1689
Mailing Address - Street 1:6614 GOODE DR
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66216-2515
Mailing Address - Country:US
Mailing Address - Phone:913-662-3415
Mailing Address - Fax:
Practice Address - Street 1:7398 W 162ND TER
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66085-8240
Practice Address - Country:US
Practice Address - Phone:402-690-1689
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1124703376Medicaid