Individual
MRS. MCKENZIE BETTE CORNILSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CLC, SBD
Contact information
Practice address
2010 E 38TH ST STE 201B, DAVENPORT, IA 52807-1179
(184) 656-2200
Mailing address
PO BOX 623, BUFFALO, IA 52728-0623
(563) 320-4698
Taxonomy
Speciality
Code
Description
License number
State
174N00000X
Lactation Consultant (Non-RN)
Primary
ALPP-330760
IA
374J00000X
Doula
—
IA
Other
Enumeration date
02/28/2024
Last updated
02/28/2024
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