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NPI Code Detail

MEDICARE: THE BREAST PLACE OF SOUTHERN OREGON, LLC

MEDICARE: THE BREAST PLACE OF SOUTHERN OREGON, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WL0100XLactation Consultant (Registered Nurse)

General Provider Information

NPI Number : 1447007836
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE BREAST PLACE OF SOUTHERN OREGON, LLC
Provider Business Mailing Address
First Line : 3302 RAYMOND ST
Second Line :
City : KLAMATH FALLS
State : OR
Zip : 97603-7050
Country : US
Telephone Number : 541-851-1639
Fax Number :
Provider Business Practice Location Address
First Line : 3302 RAYMOND ST
Second Line :
City : KLAMATH FALLS
State : OR
Zip : 97603-7050
Country : US
Telephone Number : 541-851-1639
Fax Number :
Authorized Official
Title or Position : OWNER
Name : ERIN SNODGRASS
Credential : RN, IBCLC
Telephone Number : 541-851-1639
Provider Enumeration Date : 05/02/2024
Last Update Date : 05/02/2024

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Directions to “THE BREAST PLACE OF SOUTHERN OREGON, LLC ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.