Healthcare Provider Details

I. General information

NPI: 1780952465
Provider Name (Legal Business Name): BREASTFEEDING CONNECTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2011
Last Update Date: 12/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 N LEWIS PL
TULSA OK
74110-2125
US

IV. Provider business mailing address

2211 N LEWIS PL
TULSA OK
74110
US

V. Phone/Fax

Practice location:
  • Phone: 918-902-9368
  • Fax:
Mailing address:
  • Phone: 918-902-9368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number11190051
License Number StateVA

VIII. Authorized Official

Name: SHAMMAH DELASSE
Title or Position: COO
Credential: IBCLC
Phone: 918-902-9368