Organization
NORTHWEST MOTHERS MILK BANK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LESLEY L MONDEAUX RNC,IBCLC (EXECUTIVE DIRECTOR)
(503) 332-0436
Entity
Organization
Contact information
Practice address
15875 SW 74TH AVE STE 100, TIGARD, OR 97224-7934
(503) 469-9555
(503) 469-0962
Mailing address
15875 SW 74TH AVE STE 100, TIGARD, OR 97224-7934
(503) 469-9555
(503) 469-0962
Taxonomy
Speciality
Code
Description
License number
State
251V00000X
Voluntary or Charitable Agency
542742-96
OR
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
Primary
542742-96
OR
Other
Enumeration date
12/14/2016
Last updated
04/22/2020
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