=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114603552
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BREASTFRIENDS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2023
-----------------------------------------------------
Last Update Date | 06/24/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6016 GAINSBOROUGH RD
-----------------------------------------------------
City | AMARILLO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79106-3415
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-626-9826
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6016 GAINSBOROUGH RD
-----------------------------------------------------
City | AMARILLO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79106-3415
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-626-9826
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LACTATION CONSULTANT
-----------------------------------------------------
Name | MRS. AMANDA CASTILLO
-----------------------------------------------------
Credential | RNC, IBCLC
-----------------------------------------------------
Telephone | 806-626-9826
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WL0100X
-----------------------------------------------------
Taxonomy Name | Lactation Consultant (Registered Nurse)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------