Organization
BREASTFEEDING GUIDANCE CENTER OF SOUTHWEST OKLAHOMA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JACKIE CAROLE GILLILAND RN BSN IBCLC (REGISTERED AGENT FOR THE LLC)
(580) 591-3817
Entity
Organization
Contact information
Practice address
711 SW D AVE, SUITE 207, LAWTON, OK 73501-4561
(580) 591-3817
Mailing address
8237 NW STONEBRIDGE CT, LAWTON, OK 73505-4127
(580) 536-3743
(580) 536-3743
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
R0027885
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100749570S
—
OK
Enumeration date
06/30/2009
Last updated
06/30/2009
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