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General NPI Number Information
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NPI Number | 1366244451
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Entity Type | Organization
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Legal Business Name | CORPORATE LACTATION SERVICES, INC
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Dates
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Enumeration Date | 03/27/2025
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Last Update Date | 03/27/2025
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Provider Practice Location Address
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Address Line | 1712 GREEN MOUNTAIN TPKE
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City | CHESTER
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State | VT
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Zip | 05143-8321
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Country | US
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Telephone | 802-875-5683
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Fax |
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Provider Business Mailing Address
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Address Line | 1712 GREEN MOUNTAIN TPKE
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City | CHESTER
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State | VT
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Zip | 05143-8321
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Country | US
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Telephone | 802-875-5683
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Fax |
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Authorized Official
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Title or Position | NP
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Name | AMANDA GORMAN
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Credential |
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Telephone | 917-567-5260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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