Organization
WELLSPRING LACTATION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHLEEN JUNE BOUSU RN IBCLC (PARTNER)
(763) 342-1752
Entity
Organization
Contact information
Practice address
558 KAYLA LN, HANOVER, MN 55341-4504
(877) 840-2143
Mailing address
558 KAYLA LN, HANOVER, MN 55341-4504
(763) 342-1752
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Enumeration date
11/06/2021
Last updated
11/06/2021
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