Provider Demographics
NPI:1215301858
Name:LACTATION HOME CARE
Entity type:Organization
Organization Name:LACTATION HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/IBCLC
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:VAN ORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN, IBCLC
Authorized Official - Phone:385-498-4357
Mailing Address - Street 1:1548 E GREENFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-2565
Mailing Address - Country:US
Mailing Address - Phone:385-498-4357
Mailing Address - Fax:
Practice Address - Street 1:1548 E GREENFIELD AVE
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84121-2565
Practice Address - Country:US
Practice Address - Phone:385-498-4357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-19
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT285485-3102163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty