Provider Demographics
NPI:1669111324
Name:SCALISE, ANGELA (RN IBCLC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:SCALISE
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 1:15184 MONROVIA ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66221-2366
Mailing Address - Country:US
Mailing Address - Phone:913-205-7292
Mailing Address - Fax:
Practice Address - Street 1:15184 MONROVIA ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66221-2366
Practice Address - Country:US
Practice Address - Phone:913-205-7292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-151768-111163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant