Healthcare Provider Details

I. General information

NPI: 1437644010
Provider Name (Legal Business Name): MARISSA FOSTER IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2018
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2024 ELMHURST DR
NORMAN OK
73071-1442
US

IV. Provider business mailing address

4302 HARVARD RD
NORMAN OK
73072-4428
US

V. Phone/Fax

Practice location:
  • Phone: 405-223-1340
  • Fax:
Mailing address:
  • Phone: 405-819-3382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL322217
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: