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General NPI Number Information
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NPI Number | 1326276189
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Entity Type | Organization
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Legal Business Name | BREASTFEEDING GUIDANCE CENTER OF SOUTHWEST OKLAHOMA
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Dates
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Enumeration Date | 06/30/2009
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Last Update Date | 06/30/2009
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Provider Practice Location Address
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Address Line | 711 SW D AVE SUITE 207
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City | LAWTON
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State | OK
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Zip | 73501-4561
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Country | US
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Telephone | 580-591-3817
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Fax |
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Provider Business Mailing Address
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Address Line | 8237 NW STONEBRIDGE CT
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City | LAWTON
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State | OK
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Zip | 73505-4127
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Country | US
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Telephone | 580-536-3743
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Fax | 580-536-3743
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Authorized Official
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Title or Position | REGISTERED AGENT FOR THE LLC
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Name | MRS. JACKIE CAROLE GILLILAND
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Credential | RN BSN IBCLC
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Telephone | 580-591-3817
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | R0027885
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License Number State | OK
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