Provider Demographics
NPI:1902373327
Name:GREEN COUNTRY LACTATION LLC
Entity Type:Organization
Organization Name:GREEN COUNTRY LACTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:PARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-671-4876
Mailing Address - Street 1:809 W JUNEAU ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-0765
Mailing Address - Country:US
Mailing Address - Phone:918-671-4876
Mailing Address - Fax:918-744-9657
Practice Address - Street 1:809 W JUNEAU ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-0765
Practice Address - Country:US
Practice Address - Phone:918-671-4876
Practice Address - Fax:918-744-9657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty