Provider Demographics
NPI:1063623007
Name:DANA, SUSAN R (RNC, IBCLC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:R
Last Name:DANA
Suffix:
Gender:F
Credentials:RNC, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 W 79TH ST
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-4604
Mailing Address - Country:US
Mailing Address - Phone:913-710-7811
Mailing Address - Fax:
Practice Address - Street 1:5700 W 79TH ST
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-4604
Practice Address - Country:US
Practice Address - Phone:913-710-7811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-42410-062163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS14-42410-062OtherKANSAS STATE BOARD OF NUR