Provider Demographics
NPI:1548920747
Name:MAGNOLIA LACTATION LLC
Entity type:Organization
Organization Name:MAGNOLIA LACTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:STARNES
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, IBCLC
Authorized Official - Phone:417-299-2675
Mailing Address - Street 1:1926 N TANGLEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:NIXA
Mailing Address - State:MO
Mailing Address - Zip Code:65714-9459
Mailing Address - Country:US
Mailing Address - Phone:417-299-2675
Mailing Address - Fax:
Practice Address - Street 1:1926 N TANGLEWOOD LN
Practice Address - Street 2:
Practice Address - City:NIXA
Practice Address - State:MO
Practice Address - Zip Code:65714-9459
Practice Address - Country:US
Practice Address - Phone:417-299-2675
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-29
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty