Healthcare Provider Details

I. General information

NPI: 1528676301
Provider Name (Legal Business Name): LA VIE LACTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2020
Last Update Date: 07/17/2020
Certification Date: 07/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1684 HIGHWAY 752
CHURCH POINT LA
70525-6704
US

IV. Provider business mailing address

1684 HIGHWAY 752
CHURCH POINT LA
70525-6704
US

V. Phone/Fax

Practice location:
  • Phone: 337-277-8685
  • Fax:
Mailing address:
  • Phone: 337-277-8685
  • 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: TRACY VENABLE
Title or Position: LACTATION CONSULTANT
Credential: RN, IBCLC, RLC
Phone: 337-277-8685