Provider Demographics
NPI:1124564992
Name:BABY TO BREAST
Entity Type:Organization
Organization Name:BABY TO BREAST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LACTATION CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:MARIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLTON
Authorized Official - Suffix:
Authorized Official - Credentials:RN, IBCLC
Authorized Official - Phone:253-230-1512
Mailing Address - Street 1:1538 12TH LANE FI
Mailing Address - Street 2:
Mailing Address - City:FOX ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98333-9664
Mailing Address - Country:US
Mailing Address - Phone:253-514-8411
Mailing Address - Fax:253-514-8299
Practice Address - Street 1:1538 12TH LANE FI
Practice Address - Street 2:
Practice Address - City:FOX ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98333-9664
Practice Address - Country:US
Practice Address - Phone:253-514-8411
Practice Address - Fax:253-514-8299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA88044163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty