Provider Demographics
NPI:1679113021
Name:LACTATION CONSUTANT ON THE GO LLC
Entity type:Organization
Organization Name:LACTATION CONSUTANT ON THE GO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:STAFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:RN, IBCLC
Authorized Official - Phone:575-233-3240
Mailing Address - Street 1:220 VISTA DEL REY DR
Mailing Address - Street 2:
Mailing Address - City:VADO
Mailing Address - State:NM
Mailing Address - Zip Code:88072-7236
Mailing Address - Country:US
Mailing Address - Phone:575-233-3240
Mailing Address - Fax:
Practice Address - Street 1:220 VISTA DEL REY DR
Practice Address - Street 2:
Practice Address - City:VADO
Practice Address - State:NM
Practice Address - Zip Code:88072-7236
Practice Address - Country:US
Practice Address - Phone:575-233-3240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty