Provider Demographics
NPI:1073936829
Name:BLISS AT THE BREAST
Entity Type:Organization
Organization Name:BLISS AT THE BREAST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:D
Authorized Official - Last Name:ALTEMARA
Authorized Official - Suffix:
Authorized Official - Credentials:IBCLC
Authorized Official - Phone:919-260-7202
Mailing Address - Street 1:231 FLEMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-5637
Mailing Address - Country:US
Mailing Address - Phone:919-260-7202
Mailing Address - Fax:
Practice Address - Street 1:231 FLEMINGTON RD
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-5637
Practice Address - Country:US
Practice Address - Phone:919-260-7202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty