Provider Demographics
NPI:1306403209
Name:GOEBEL, ELISABETH A (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:A
Last Name:GOEBEL
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 1:11804 W SHERIAC ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67209-2915
Mailing Address - Country:US
Mailing Address - Phone:316-202-8264
Mailing Address - Fax:
Practice Address - Street 1:11804 W SHERIAC ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67209-6720
Practice Address - Country:US
Practice Address - Phone:316-202-8264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-26
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS111767163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty