Healthcare Provider Details

I. General information

NPI: 1497672307
Provider Name (Legal Business Name): FOVEO LACTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9707 62ND AVE SE
OLYMPIA WA
98513-9204
US

IV. Provider business mailing address

9707 62ND AVE SE
OLYMPIA WA
98513-9204
US

V. Phone/Fax

Practice location:
  • Phone: 408-835-6368
  • Fax: 253-248-6409
Mailing address:
  • Phone: 408-835-6368
  • Fax: 253-248-6409

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: MRS. STEFANIE ANDERSON
Title or Position: OWNER
Credential: RN, BSN, IBCLC
Phone: 408-835-6368