Provider Demographics
NPI:1326411091
Name:MACTAGGART, CORTNEY AUSTIN (IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:CORTNEY
Middle Name:AUSTIN
Last Name:MACTAGGART
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 1:2802 ARROWHEAD LN
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-4612
Mailing Address - Country:US
Mailing Address - Phone:402-515-7886
Mailing Address - Fax:
Practice Address - Street 1:2802 ARROWHEAD LN
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-4612
Practice Address - Country:US
Practice Address - Phone:402-515-7886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEL-82469174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN