Provider Demographics
NPI:1376297044
Name:LOVEBLOSSOM, LLC
Entity Type:Organization
Organization Name:LOVEBLOSSOM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LACTATION CONSULTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:A
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:IBCLC, RNC-OB
Authorized Official - Phone:907-738-4507
Mailing Address - Street 1:17307 SNEE OOSH RD
Mailing Address - Street 2:
Mailing Address - City:LA CONNER
Mailing Address - State:WA
Mailing Address - Zip Code:98257-9112
Mailing Address - Country:US
Mailing Address - Phone:907-738-4507
Mailing Address - Fax:
Practice Address - Street 1:17307 SNEE OOSH RD
Practice Address - Street 2:
Practice Address - City:LA CONNER
Practice Address - State:WA
Practice Address - Zip Code:98257-9112
Practice Address - Country:US
Practice Address - Phone:907-738-4507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
1699965392OtherNPI NUMBER, INDIVIDUAL