Active NPI
Angela Len Lull, IBCLC, LMT,CST,DOULA
- Lactation Consultant (Non-RN)
- Bend, OR
National Provider Identifier
1053997254
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Lactation Consultant (Non-RN)
- License
- LC-LC-10214114
- Practice address
- 2200 NE Professional CT
Bend, OR 97701-6063 - Phone
- (541) 389-6313
- Fax
- (541) 389-8760
- NPI assigned
- Mar 19, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 26277 | OR | |
| Lactation Consultant (Non-RN) | 174N00000X | LC-LC-10214114 | OR | Primary |
Addresses
Primary practice location
2200 NE Professional CT
Bend, OR 97701-6063
Mailing address
2200 NE Professional CT
Bend, OR 97701-6063
Phone (541) 389-6313
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LC-LC-10214114 | OR | MD | Lactation Consultant (Non-RN) |
| 26277 | OR | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1616112000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1652745600000",
"number": "1053997254",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2200 NE PROFESSIONAL CT",
"city": "BEND",
"state": "OR",
"postal_code": "977016063",
"telephone_number": "541-389-6313",
"fax_number": "541-389-8760"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2200 NE PROFESSIONAL CT",
"city": "BEND",
"state": "OR",
"postal_code": "977016063",
"telephone_number": "541-389-6313",
"fax_number": "541-389-8760"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LULL",
"first_name": "ANGELA",
"middle_name": "LEN",
"credential": "IBCLC, LMT,CST,DOULA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-03-19",
"last_updated": "2022-05-17",
"certification_date": "2022-05-14",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "OR",
"license": "26277",
"primary": false
},
{
"code": "174N00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Lactation Consultant, Non-RN",
"state": "OR",
"license": "LC-LC-10214114",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bend, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.