Provider Demographics
NPI:1336660604
Name:SERENITY BREASTFEEDING SUPPORT LLC
Entity Type:Organization
Organization Name:SERENITY BREASTFEEDING SUPPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:BA, IBCLC
Authorized Official - Phone:501-725-1275
Mailing Address - Street 1:6385 WALNUT CV
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72019-1511
Mailing Address - Country:US
Mailing Address - Phone:501-554-5550
Mailing Address - Fax:
Practice Address - Street 1:6385 WALNUT CV
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72019-1511
Practice Address - Country:US
Practice Address - Phone:501-554-5550
Practice Address - Fax:501-613-0391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARL-108255174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty