Provider Demographics
NPI:1568845592
Name:DESERT JOURNEY, LLC
Entity Type:Organization
Organization Name:DESERT JOURNEY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LACTATION CONSULTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:R
Authorized Official - Last Name:KERNEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN IBCLC
Authorized Official - Phone:513-265-5486
Mailing Address - Street 1:904 E PRESCOTT PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-5131
Mailing Address - Country:US
Mailing Address - Phone:513-265-5486
Mailing Address - Fax:
Practice Address - Street 1:904 E PRESCOTT PL
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-5131
Practice Address - Country:US
Practice Address - Phone:513-265-5486
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-08
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH196-13364302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization