Provider Demographics
NPI:1508368978
Name:MIDWEST MILK LLC
Entity Type:Organization
Organization Name:MIDWEST MILK LLC
Other - Org Name:MIDWEST MILK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:DITTRICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-841-1802
Mailing Address - Street 1:84150 529TH AVE
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:NE
Mailing Address - Zip Code:68761-3039
Mailing Address - Country:US
Mailing Address - Phone:402-841-1802
Mailing Address - Fax:
Practice Address - Street 1:15507 EDNA ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68138-6483
Practice Address - Country:US
Practice Address - Phone:402-841-1802
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEL-68698163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty