Provider Demographics
NPI:1902623242
Name:JENNIFER AIST LACTATION SERVICES
Entity type:Organization
Organization Name:JENNIFER AIST LACTATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:AIST
Authorized Official - Suffix:
Authorized Official - Credentials:IBCLC-RLC
Authorized Official - Phone:907-602-2974
Mailing Address - Street 1:4700 MARS DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-3725
Mailing Address - Country:US
Mailing Address - Phone:907-602-2974
Mailing Address - Fax:907-563-7048
Practice Address - Street 1:4700 MARS DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-3725
Practice Address - Country:US
Practice Address - Phone:907-602-2974
Practice Address - Fax:907-563-7048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty
No163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Multi-Specialty