Provider Demographics
NPI:1568174589
Name:OREM LACTATION CLINIC
Entity Type:Organization
Organization Name:OREM LACTATION CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE-LICENSED LACTATION
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:V
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-714-3324
Mailing Address - Street 1:OREM COMMUNITY HOSPITAL
Mailing Address - Street 2:331 NORTH 400 WEST
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057
Mailing Address - Country:US
Mailing Address - Phone:801-714-3324
Mailing Address - Fax:
Practice Address - Street 1:OREM COMMUNITY HOSPITAL
Practice Address - Street 2:331 NORTH 400 WEST
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057
Practice Address - Country:US
Practice Address - Phone:801-714-3324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-21
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty