Healthcare Provider Details

I. General information

NPI: 1881291144
Provider Name (Legal Business Name): LACTATION CARE WITH ELIZABETH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2020
Last Update Date: 10/08/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 DENNIS DR
LEXINGTON KY
40503-2917
US

IV. Provider business mailing address

557 MEADOWCREST PARK
LEXINGTON KY
40515-4811
US

V. Phone/Fax

Practice location:
  • Phone: 859-351-1032
  • Fax:
Mailing address:
  • Phone: 859-351-1032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH ANNE STAPLETON
Title or Position: OWNER
Credential: RN, IBCLC
Phone: 859-351-1032