Healthcare Provider Details

I. General information

NPI: 1083317762
Provider Name (Legal Business Name): LACTATION CONSULTATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2023
Last Update Date: 09/07/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 W FALL CREEK PARKWAY SOUTH DR
INDIANAPOLIS IN
46208-5736
US

IV. Provider business mailing address

133 W MARKET ST STE 125
INDIANAPOLIS IN
46204-2801
US

V. Phone/Fax

Practice location:
  • Phone: 323-595-4006
  • Fax: 310-872-1533
Mailing address:
  • Phone: 323-595-4006
  • Fax: 310-872-1533

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: NICOLE PELUSO
Title or Position: PRESIDENT
Credential: IBCLC
Phone: 323-595-4006