Provider Demographics
NPI:1861660011
Name:BREASTFEEDING SUPPORT & SUPPLIES OF OMAHA
Entity Type:Organization
Organization Name:BREASTFEEDING SUPPORT & SUPPLIES OF OMAHA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED LACTATION CONSULTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:ANNETTE
Authorized Official - Last Name:ERDMANN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:402-707-1696
Mailing Address - Street 1:6017 S 167TH CIR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-2393
Mailing Address - Country:US
Mailing Address - Phone:402-707-1696
Mailing Address - Fax:402-932-8581
Practice Address - Street 1:6017 S 167TH CIR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68135-2393
Practice Address - Country:US
Practice Address - Phone:402-707-1696
Practice Address - Fax:402-932-8581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE29841332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025817000Medicaid