Provider Demographics
NPI:1730792110
Name:ADVANCED BREASTFEEDING MEDICINE OF NEW ORLEANS LLC
Entity type:Organization
Organization Name:ADVANCED BREASTFEEDING MEDICINE OF NEW ORLEANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNERS,
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:CREDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-296-2955
Mailing Address - Street 1:3305 METAIRIE RD
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-5215
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3305 METAIRIE RD
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-5215
Practice Address - Country:US
Practice Address - Phone:504-358-8411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty