Healthcare Provider Details

I. General information

NPI: 1992361950
Provider Name (Legal Business Name): SIMPLY FED LACTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2019
Last Update Date: 05/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 LONGWATER DR
HANOVER MA
02339-1867
US

IV. Provider business mailing address

152 LONGWATER DR
HANOVER MA
02339-1867
US

V. Phone/Fax

Practice location:
  • Phone: 781-635-6479
  • Fax:
Mailing address:
  • Phone: 781-635-6479
  • 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: ELLEN FITZGERALD
Title or Position: MANAGER
Credential: BSN, RN, IBCLC
Phone: 781-635-6479