Provider Demographics
NPI:1477024628
Name:FAIRHAVEN LACTATION, LLC
Entity Type:Organization
Organization Name:FAIRHAVEN LACTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANCELL
Authorized Official - Suffix:
Authorized Official - Credentials:IBCLC
Authorized Official - Phone:360-305-1673
Mailing Address - Street 1:1515 LARRABEE AVE
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-7429
Mailing Address - Country:US
Mailing Address - Phone:360-305-1673
Mailing Address - Fax:
Practice Address - Street 1:1515 LARRABEE AVE
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-7429
Practice Address - Country:US
Practice Address - Phone:360-305-1673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty