Healthcare Provider Details

I. General information

NPI: 1063565554
Provider Name (Legal Business Name): BREASTFEEDING RESOURCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8801 LAGRIMA DE ORO RD NE
ALBUQUERQUE NM
87111-2354
US

IV. Provider business mailing address

8801 LAGRIMA DE ORO RD NE
ALBUQUERQUE NM
87111-2354
US

V. Phone/Fax

Practice location:
  • Phone: 505-293-5215
  • Fax: 505-237-1542
Mailing address:
  • Phone: 505-293-5215
  • Fax: 505-237-1542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MS. JACQUELINE CORYELL
Title or Position: OWNER
Credential: BA, IBCLC
Phone: 505-293-5215