Provider Demographics
NPI:1518407758
Name:RN BREASTFEEDING SUPPORT LLC
Entity type:Organization
Organization Name:RN BREASTFEEDING SUPPORT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, MEDICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BREANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP FNP-C
Authorized Official - Phone:425-903-1163
Mailing Address - Street 1:13002 54TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-9548
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13002 54TH AVE SE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-9548
Practice Address - Country:US
Practice Address - Phone:425-903-1163
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-07
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60400899163W00000X
WAAP60665822363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty