Provider Demographics
NPI:1518391226
Name:ARIZONA BREASTFEEDING CENTER, LLC
Entity Type:Organization
Organization Name:ARIZONA BREASTFEEDING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BEVER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, IBCLC
Authorized Official - Phone:858-442-8266
Mailing Address - Street 1:4701 S LAKESHORE DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7169
Mailing Address - Country:US
Mailing Address - Phone:480-269-1639
Mailing Address - Fax:
Practice Address - Street 1:4701 S LAKESHORE DR
Practice Address - Street 2:SUITE 2
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7169
Practice Address - Country:US
Practice Address - Phone:480-269-1639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty