Provider Demographics
NPI:1255038410
Name:AMARYLLIS LACTATION SUPPORT LLC
Entity type:Organization
Organization Name:AMARYLLIS LACTATION SUPPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERINN
Authorized Official - Middle Name:
Authorized Official - Last Name:TANGUAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-908-3500
Mailing Address - Street 1:31 HOOPERS LN
Mailing Address - Street 2:
Mailing Address - City:CANTERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06331-1467
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:31 HOOPERS LN
Practice Address - Street 2:
Practice Address - City:CANTERBURY
Practice Address - State:CT
Practice Address - Zip Code:06331-1467
Practice Address - Country:US
Practice Address - Phone:860-908-3500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-08
Last Update Date:2023-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty