Healthcare Provider Details

I. General information

NPI: 1467166835
Provider Name (Legal Business Name): LACI JONES RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2023
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 14TH ST N # 4
FARGO ND
58102-4216
US

IV. Provider business mailing address

1124 8TH ST N
MOORHEAD MN
56560-1504
US

V. Phone/Fax

Practice location:
  • Phone: 701-335-6050
  • Fax: 701-781-8057
Mailing address:
  • Phone: 605-216-8257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-303225
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number2392305
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: