Provider Demographics
NPI:1114665353
Name:MIZNER, NATASHA KAY (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:KAY
Last Name:MIZNER
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:402-690-1689
Mailing Address - Fax:
Practice Address - Street 1:6614 GOODE DR
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66216-2515
Practice Address - Country:US
Practice Address - Phone:402-690-1689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS136401163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant