Provider Demographics
NPI:1730670514
Name:FLAGSTAFF BREASTFEEDING CENTER, LLC
Entity Type:Organization
Organization Name:FLAGSTAFF BREASTFEEDING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:PELLETIER-BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-556-0000
Mailing Address - Street 1:401 W ASPEN AVE
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-5305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:401 W ASPEN AVE
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-5305
Practice Address - Country:US
Practice Address - Phone:928-556-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLAGSTAFF BIRTH AND WOMEN'S HEALTH, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-28
Last Update Date:2018-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center