Provider Demographics
NPI:1992361950
Name:SIMPLY FED LACTATION
Entity Type:Organization
Organization Name:SIMPLY FED LACTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, RN, IBCLC
Authorized Official - Phone:781-635-6479
Mailing Address - Street 1:152 LONGWATER DR
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02339-1867
Mailing Address - Country:US
Mailing Address - Phone:781-635-6479
Mailing Address - Fax:
Practice Address - Street 1:152 LONGWATER DR
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MA
Practice Address - Zip Code:02339-1867
Practice Address - Country:US
Practice Address - Phone:781-635-6479
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-15
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty