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General NPI Number Information
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NPI Number | 1699030932
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Entity Type | Organization
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Legal Business Name | LOVE OF LACTATION
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Dates
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Enumeration Date | 07/12/2012
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Last Update Date | 07/12/2012
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Provider Practice Location Address
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Address Line | 20334 SW JAY ST
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City | BEAVERTON
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State | OR
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Zip | 97006-8026
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Country | US
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Telephone | 503-848-3483
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Fax |
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Provider Business Mailing Address
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Address Line | 20334 SW JAY ST
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City | BEAVERTON
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State | OR
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Zip | 97006-8026
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Country | US
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Telephone | 503-848-3483
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GRACE VANDOMELEN
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Credential | RN, IBCLC
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Telephone | 503-848-3483
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WL0100X
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Taxonomy Name | Lactation Consultant (Registered Nurse)
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License Number | 200342213RN
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License Number State | OR
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