Healthcare Provider Details

I. General information

NPI: 1770125049
Provider Name (Legal Business Name): ALLY LACTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2019
Last Update Date: 04/07/2020
Certification Date: 04/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9901 N MAY AVE STE 110
OKLAHOMA CITY OK
73120-2734
US

IV. Provider business mailing address

816 MARS CIR
EDMOND OK
73003-6060
US

V. Phone/Fax

Practice location:
  • Phone: 405-849-5624
  • Fax:
Mailing address:
  • Phone: 405-314-0620
  • 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: SARAH DABNEY BENDURE
Title or Position: LACTATION CONSULTANT/OWNER
Credential: RN, IBCLC
Phone: 405-849-5624