Organization
NOURISH LACTATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BROOKE BORGOGNONI IBCLC (OWNER)
(541) 306-4299
Entity
Organization
Contact information
Practice address
19820 VILLAGE OFFICE CT STE 201, BEND, OR 97702-2949
(541) 306-4299
Mailing address
19334 MOHAWK RD, BEND, OR 97702-8908
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
—
133VN1004X
Pediatric Nutrition Registered Dietitian
—
—
163WL0100X
Lactation Consultant (Registered Nurse)
—
—
174N00000X
Lactation Consultant (Non-RN)
Primary
—
—
208D00000X
General Practice Physician
—
—
2251P0200X
Pediatric Physical Therapist
—
—
Other
Enumeration date
01/10/2020
Last updated
12/18/2023
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