Healthcare Provider Details

I. General information

NPI: 1396002093
Provider Name (Legal Business Name): WILLAMETTE VALLEY LACTATION CONSULTANTS,LLC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2012
Last Update Date: 04/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 CHARNELTON ST SUITE 7
EUGENE OR
97401-6214
US

IV. Provider business mailing address

1245 CHARNELTON ST SUITE 7
EUGENE OR
97401-6214
US

V. Phone/Fax

Practice location:
  • Phone: 541-556-4240
  • Fax:
Mailing address:
  • Phone: 541-556-4240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number201140669RN
License Number StateOR

VIII. Authorized Official

Name: KALLEN S. KORIN
Title or Position: LACTATION CONSULTANT
Credential: RN,IBCLC
Phone: 541-556-4240