Healthcare Provider Details

I. General information

NPI: 1518391226
Provider Name (Legal Business Name): ARIZONA BREASTFEEDING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2013
Last Update Date: 08/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 S LAKESHORE DR SUITE 2
TEMPE AZ
85282-7169
US

IV. Provider business mailing address

4701 S LAKESHORE DR SUITE 2
TEMPE AZ
85282-7169
US

V. Phone/Fax

Practice location:
  • Phone: 480-269-1639
  • Fax:
Mailing address:
  • Phone: 480-269-1639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name: DR. JENNIE LYNN BEVER
Title or Position: MANAGER
Credential: PHD, IBCLC
Phone: 858-442-8266