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General NPI Number Information
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NPI Number | 1497170161
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Entity Type | Organization
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Legal Business Name | EMILIA SMITH
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Dates
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Enumeration Date | 03/04/2014
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Last Update Date | 03/04/2014
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Provider Practice Location Address
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Address Line | 1424 NE 74TH AVE
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City | PORTLAND
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State | OR
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Zip | 97213-6123
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Country | US
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Telephone | 503-805-1143
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Fax |
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Provider Business Mailing Address
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Address Line | 1424 NE 74TH AVE
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City | PORTLAND
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State | OR
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Zip | 97213-6123
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Country | US
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Telephone | 503-805-1143
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Fax |
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Authorized Official
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Title or Position | LACTATION CONSULTANT
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Name | EMILIA MEGTALEENA SMITH
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Credential | IBCLC
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Telephone | 503-805-1143
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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 | L-47067
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License Number State | OR
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