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General NPI Number Information
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NPI Number | 1417793746
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Entity Type | Organization
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Legal Business Name | WILDFLOWER LACTATION
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Dates
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Enumeration Date | 07/05/2024
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Last Update Date | 10/22/2025
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Provider Practice Location Address
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Address Line | 3323 SW NAITO PKWY
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City | PORTLAND
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State | OR
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Zip | 97239-4672
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Country | US
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Telephone | 503-755-8328
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Fax |
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Provider Business Mailing Address
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Address Line | 462 SW VALERIA VIEW DR APT 303
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City | PORTLAND
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State | OR
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Zip | 97225-7085
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Country | US
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Telephone | 503-755-8328
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ELIZABETH E WATERS
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Credential | IBCLC
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Telephone | 541-645-3018
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174N00000X
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Taxonomy Name | Lactation Consultant (Non-RN)
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License Number |
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License Number State |
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