Provider Demographics
NPI:1386960987
Name:LACTATION CARE CONSULTING LLC
Entity type:Organization
Organization Name:LACTATION CARE CONSULTING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LACTATION CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:KRISTINE
Authorized Official - Last Name:VINSON
Authorized Official - Suffix:
Authorized Official - Credentials:RNC-OB, IBCLC, RLC
Authorized Official - Phone:405-761-1644
Mailing Address - Street 1:1205 S AIR DEPOT BLVD
Mailing Address - Street 2:263
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-4807
Mailing Address - Country:US
Mailing Address - Phone:405-761-1644
Mailing Address - Fax:
Practice Address - Street 1:2144 CLEARWATER DR
Practice Address - Street 2:
Practice Address - City:CHOCTAW
Practice Address - State:OK
Practice Address - Zip Code:73020-6237
Practice Address - Country:US
Practice Address - Phone:405-761-1644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR90483163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty