Provider Demographics
NPI:1023621026
Name:KUSS, BECKY J (RN IBCLC)
Entity type:Individual
Prefix:
First Name:BECKY
Middle Name:J
Last Name:KUSS
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 1:403 LAREDO DR
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-7212
Mailing Address - Country:US
Mailing Address - Phone:701-471-2258
Mailing Address - Fax:
Practice Address - Street 1:1471 INTERSTATE LOOP STE 4
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-1378
Practice Address - Country:US
Practice Address - Phone:701-202-8423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR25792163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty