Provider Demographics
NPI:1083383053
Name:MILK MEDIC, LLC
Entity Type:Organization
Organization Name:MILK MEDIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEFANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN, IBCLC
Authorized Official - Phone:901-626-6135
Mailing Address - Street 1:375 RICHARDSON LAKES DRIVE
Mailing Address - Street 2:
Mailing Address - City:DRUMMONDS
Mailing Address - State:TN
Mailing Address - Zip Code:38023
Mailing Address - Country:US
Mailing Address - Phone:901-626-6135
Mailing Address - Fax:901-443-1228
Practice Address - Street 1:375 RICHARDSON LAKES DR
Practice Address - Street 2:
Practice Address - City:DRUMMONDS
Practice Address - State:TN
Practice Address - Zip Code:38023-6278
Practice Address - Country:US
Practice Address - Phone:901-626-6135
Practice Address - Fax:901-443-1228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-12
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty