Healthcare Provider Details

I. General information

NPI: 1780476457
Provider Name (Legal Business Name): MOTHER NURTURE LACTATION CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

396 PHILBIN RD
POCATELLO ID
83202-7071
US

IV. Provider business mailing address

396 PHILBIN RD
POCATELLO ID
83202-7071
US

V. Phone/Fax

Practice location:
  • Phone: 208-241-1013
  • Fax:
Mailing address:
  • Phone: 208-241-1013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number
License Number State

VIII. Authorized Official

Name: LAURA LUNDQUIST
Title or Position: OWNER/AUTH OFFICIAL
Credential: BS, BSN, RN, IBCLC
Phone: 208-241-1013