Organization
BREASTFEEDING RESOURCES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JACQUELINE CORYELL BA, IBCLC (OWNER)
(505) 293-5215
Entity
Organization
Contact information
Practice address
8801 LAGRIMA DE ORO RD NE, ALBUQUERQUE, NM 87111-2354
(505) 293-5215
(505) 237-1542
Mailing address
8801 LAGRIMA DE ORO RD NE, ALBUQUERQUE, NM 87111-2354
(505) 293-5215
(505) 237-1542
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000T3994
—
NM
Enumeration date
01/19/2007
Last updated
08/22/2020
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