Provider Demographics
NPI:1649030917
Name:LEGACY LACTATION SERVICES, LLC
Entity type:Organization
Organization Name:LEGACY LACTATION SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:IBCLC
Authorized Official - Phone:423-321-2528
Mailing Address - Street 1:8310 FRONT GATE CIR
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-9506
Mailing Address - Country:US
Mailing Address - Phone:423-321-2528
Mailing Address - Fax:
Practice Address - Street 1:8310 FRONT GATE CIR
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-9506
Practice Address - Country:US
Practice Address - Phone:423-321-2528
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty