Provider Demographics
NPI:1821687617
Name:EXPRESSION LACTATION LLC
Entity Type:Organization
Organization Name:EXPRESSION LACTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHONES
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, RN, IBCLC
Authorized Official - Phone:580-246-4314
Mailing Address - Street 1:PO BOX 65
Mailing Address - Street 2:
Mailing Address - City:CANUTE
Mailing Address - State:OK
Mailing Address - Zip Code:73626-0065
Mailing Address - Country:US
Mailing Address - Phone:580-821-6925
Mailing Address - Fax:
Practice Address - Street 1:112 MEADOW RIDGE DR
Practice Address - Street 2:
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-9732
Practice Address - Country:US
Practice Address - Phone:580-246-4314
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-15
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty
No163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty