Provider Demographics
NPI:1992542534
Name:GULF COAST BREASTFEEDING CENTER LLC
Entity type:Organization
Organization Name:GULF COAST BREASTFEEDING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:IBCLC
Authorized Official - Prefix:
Authorized Official - First Name:MARANDA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:NYBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-669-5645
Mailing Address - Street 1:6340 KILN DELISLE RD STE C
Mailing Address - Street 2:
Mailing Address - City:PASS CHRISTIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39571-9719
Mailing Address - Country:US
Mailing Address - Phone:228-669-5645
Mailing Address - Fax:
Practice Address - Street 1:6340 KILN DELISLE RD STE C
Practice Address - Street 2:
Practice Address - City:PASS CHRISTIAN
Practice Address - State:MS
Practice Address - Zip Code:39571-9719
Practice Address - Country:US
Practice Address - Phone:228-669-5645
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service