Healthcare Provider Details

I. General information

NPI: 1346058302
Provider Name (Legal Business Name): ABBY PITTS IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2024
Last Update Date: 12/23/2024
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 VANNAH AVE
PORTLAND ME
04103-4509
US

IV. Provider business mailing address

287 OSSIPEE TRL
LIMINGTON ME
04049-3532
US

V. Phone/Fax

Practice location:
  • Phone: 207-939-3226
  • Fax:
Mailing address:
  • Phone: 207-939-3226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-317295
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: