Healthcare Provider Details

I. General information

NPI: 1437752987
Provider Name (Legal Business Name): ESSENTIAL BREASTFEEDING SUPPORT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2020
Last Update Date: 04/16/2021
Certification Date: 04/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3239 S 188TH AVE
OMAHA NE
68130-6068
US

IV. Provider business mailing address

3239 S 188TH AVE
OMAHA NE
68130-6068
US

V. Phone/Fax

Practice location:
  • Phone: 402-383-1746
  • Fax:
Mailing address:
  • Phone: 402-383-1746
  • 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: MS. ERIN VALASEK
Title or Position: OWNER
Credential: RN, BSN, IBCLC
Phone: 402-383-1746