Professional Breastfeeding Support LLC

Primary specialty

Lactation Consultant (Registered Nurse)Taxonomy code 163WL0100X

Legal business name

PROFESSIONAL BREASTFEEDING SUPPORT LLC

Practice address

4630 W Walton Blvd
Waterford, MI 48329-3535

Phone

(248) 795-1984

NPI assigned

Mar 3, 2016

Organization subpart

No

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

Authorized official

Name

Ms. Pamela Anzicek, RN IBCLC

Title

Owner/Ibclc

Phone

(248) 795-1984

Specialties & licenses 3

Addresses

Locations

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

{
    "created_epoch": "1456963200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1456963200000",
    "number": "1902266919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4630 W WALTON BLVD",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "483293535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4630 W WALTON BLVD",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "483293535",
            "telephone_number": "248-795-1984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL BREASTFEEDING SUPPORT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-03",
        "last_updated": "2016-03-03",
        "status": "A",
        "authorized_official_last_name": "ANZICEK",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_title_or_position": "OWNER/IBCLC",
        "authorized_official_telephone_number": "248-795-1984",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RN IBCLC"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163WL0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Lactation Consultant",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "174N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Lactation Consultant, Non-RN",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2016; 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.