Provider Demographics
NPI:1295359974
Name:LOTTIE'S LACTATION SERVICES
Entity Type:Organization
Organization Name:LOTTIE'S LACTATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LOTTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, IBCLC
Authorized Official - Phone:850-895-9922
Mailing Address - Street 1:495 GRAND BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32550-1897
Mailing Address - Country:US
Mailing Address - Phone:850-895-9922
Mailing Address - Fax:850-465-8999
Practice Address - Street 1:495 GRAND BLVD STE 206
Practice Address - Street 2:
Practice Address - City:MIRAMAR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32550-1897
Practice Address - Country:US
Practice Address - Phone:850-895-9922
Practice Address - Fax:850-465-8999
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BUNGALO LANE CAPITAL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty