Active NPI
Jenna Zietzke, IBCLC
- Lactation Consultant (Non-RN)
- Sheridan, WY
National Provider Identifier
1609255538
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Lactation Consultant (Non-RN)
- License
- L-65702
- Practice address
- 1376 Ridgeway Ave
Sheridan, WY 82801-2488 - Phone
- (303) 305-9471
- NPI assigned
- May 26, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Lactation Consultant (Non-RN) | 174N00000X | L-65702 | WY | Primary |
Addresses
Primary practice location
1376 Ridgeway Ave
Sheridan, WY 82801-2488
Mailing address
1376 Ridgeway Ave
Sheridan, WY 82801-2488
Phone (303) 305-9471
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L-65702 | WY | MD | Lactation Consultant (Non-RN) |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1432598400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1432598400000",
"number": "1609255538",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1376 RIDGEWAY AVE",
"city": "SHERIDAN",
"state": "WY",
"postal_code": "828012488",
"telephone_number": "303-305-9471"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1376 RIDGEWAY AVE",
"city": "SHERIDAN",
"state": "WY",
"postal_code": "828012488",
"telephone_number": "303-305-9471"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ZIETZKE",
"first_name": "JENNA",
"credential": "IBCLC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-05-26",
"last_updated": "2015-05-26",
"status": "A"
},
"taxonomies": [
{
"code": "174N00000X",
"taxonomy_group": "",
"desc": "Lactation Consultant, Non-RN",
"state": "WY",
"license": "L-65702",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sheridan, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.