Northwest Mothers Milk Bank

Primary specialty

Parenteral & Enteral Nutrition Supplies (DME)Taxonomy code 332BP3500X

License

542742-96 Issued in OR

Legal business name

NORTHWEST MOTHERS MILK BANK

Practice address

15875 SW 74TH Ave Ste 100
Tigard, OR 97224-7934

Phone

(503) 469-9555

Fax

(503) 469-0962

NPI assigned

Dec 14, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lesley L Mondeaux, RNC,IBCLC

Title

Executive Director

Phone

(503) 332-0436

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1481673600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587513600000",
    "number": "1215471909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15875 SW 74TH AVE STE 100",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972247934",
            "telephone_number": "503-469-9555",
            "fax_number": "503-469-0962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15875 SW 74TH AVE STE 100",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972247934",
            "telephone_number": "503-469-9555",
            "fax_number": "503-469-0962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST MOTHERS MILK BANK",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-14",
        "last_updated": "2020-04-22",
        "certification_date": "2020-04-22",
        "status": "A",
        "authorized_official_last_name": "MONDEAUX",
        "authorized_official_first_name": "LESLEY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "503-332-0436",
        "authorized_official_credential": "RNC,IBCLC"
    },
    "taxonomies": [
        {
            "code": "251V00000X",
            "taxonomy_group": "",
            "desc": "Voluntary or Charitable",
            "state": "OR",
            "license": "542742-96",
            "primary": false
        },
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": "OR",
            "license": "542742-96",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Parenteral & Enteral Nutrition Supplies (DME) in Tigard, OR
• Providers in Tigard, OR by specialty
• Parenteral & Enteral Nutrition Supplies (DME) in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.