Provider Demographics
NPI:1124527254
Name:BREASTFEEDING PROFESSIONALS OF NORTH TEXAS
Entity type:Organization
Organization Name:BREASTFEEDING PROFESSIONALS OF NORTH TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LACTATION CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:RANGEL
Authorized Official - Suffix:
Authorized Official - Credentials:RN IBCLC
Authorized Official - Phone:817-999-8122
Mailing Address - Street 1:900 CIRCLE LN
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-7410
Mailing Address - Country:US
Mailing Address - Phone:817-999-8122
Mailing Address - Fax:
Practice Address - Street 1:900 CIRCLE LN
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-7410
Practice Address - Country:US
Practice Address - Phone:817-999-8122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TINA RANGEL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-02-05
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX796546163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX796546OtherTEXAS BOARD OF NURSING
L-47019OtherINTERNATION BOARD OF LACTATION CONSULTANT EXAMINERS