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General NPI Number Information
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NPI Number | 1023909017
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Entity Type | Organization
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Legal Business Name | LACTATION RESOURCE CENTER LLC
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Dates
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Enumeration Date | 07/09/2025
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Last Update Date | 07/09/2025
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Provider Practice Location Address
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Address Line | 2001 E 70TH ST STE 215
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City | SHREVEPORT
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State | LA
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Zip | 71105-5360
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Country | US
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Telephone | 318-862-0112
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Fax |
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Provider Business Mailing Address
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Address Line | 10414 WILLOUGHBY CIR
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City | KEITHVILLE
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State | LA
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Zip | 71047-9564
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | MRS. BRENDA F DALTON
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Credential | RNC, IBCLC
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Telephone | 318-349-6991
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WL0100X
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Taxonomy Name | Lactation Consultant (Registered Nurse)
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License Number |
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License Number State |
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