Healthcare Provider Details

I. General information

NPI: 1194319764
Provider Name (Legal Business Name): BADGERLAND BREASTFEEDING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2021
Last Update Date: 02/24/2021
Certification Date: 02/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17718 MARQUETTE RD
REEDSVILLE WI
54230-9010
US

IV. Provider business mailing address

PO BOX 135
REEDSVILLE WI
54230
US

V. Phone/Fax

Practice location:
  • Phone: 920-289-8834
  • Fax:
Mailing address:
  • Phone: 920-289-8834
  • 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: ACACIA ELMER
Title or Position: IBCLC
Credential: IBCLC
Phone: 920-289-8834