=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164217907
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CONNECTIONS LACTATION CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2025
-----------------------------------------------------
Last Update Date | 04/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7592 E PALO VERDE ST
-----------------------------------------------------
City | PRESCOTT VALLEY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86314-3235
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-830-1642
-----------------------------------------------------
Fax | 602-429-8439
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3424 W TANYA TRL
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85086-4328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-402-0413
-----------------------------------------------------
Fax | 602-429-8439
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PROVIDER
-----------------------------------------------------
Name | CAROL E KIDD
-----------------------------------------------------
Credential | IBCLC
-----------------------------------------------------
Telephone | 602-402-0413
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174N00000X
-----------------------------------------------------
Taxonomy Name | Lactation Consultant (Non-RN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------