Provider Demographics
NPI:1215408471
Name:MANSKER, MICHELLE R (IBCLC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:R
Last Name:MANSKER
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2504 PARKCREST DR
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-5313
Mailing Address - Country:US
Mailing Address - Phone:187-088-2524
Mailing Address - Fax:
Practice Address - Street 1:2504 PARKCREST DR
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-5313
Practice Address - Country:US
Practice Address - Phone:870-882-5240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARL-104476174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN