=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669263851
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANACORTES LACTATION AND WELLNESS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2025
-----------------------------------------------------
Last Update Date | 05/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11080 HAPPY VALLEY RD
-----------------------------------------------------
City | ANACORTES
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98221-4356
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-230-8350
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1415 COMMERCIAL AVE # 238
-----------------------------------------------------
City | ANACORTES
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98221-2232
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-230-8350
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | IBCLC/ FOUNDER
-----------------------------------------------------
Name | JESSICA DONOVAN
-----------------------------------------------------
Credential | BSN, RN, IBCLC
-----------------------------------------------------
Telephone | 360-230-8350
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 251J00000X
-----------------------------------------------------
Taxonomy Name | Nursing Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------