Provider Demographics
NPI:1386183812
Name:LULLABY LACTATION LLC
Entity Type:Organization
Organization Name:LULLABY LACTATION LLC
Other - Org Name:LULLABY LACTATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSAMYN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BOTHWELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN, IBCLC
Authorized Official - Phone:503-997-2684
Mailing Address - Street 1:PO BOX 75
Mailing Address - Street 2:
Mailing Address - City:NORTH PLAINS
Mailing Address - State:OR
Mailing Address - Zip Code:97133-0075
Mailing Address - Country:US
Mailing Address - Phone:503-997-2684
Mailing Address - Fax:
Practice Address - Street 1:39643 NW MURTAUGH RD
Practice Address - Street 2:
Practice Address - City:NORTH PLAINS
Practice Address - State:OR
Practice Address - Zip Code:97133-6143
Practice Address - Country:US
Practice Address - Phone:503-647-5189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200140760RN163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty