Provider Demographics
NPI:1558055426
Name:SUCCESSFULLY NURTURED COLLECTIVE LLC
Entity Type:Organization
Organization Name:SUCCESSFULLY NURTURED COLLECTIVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/IBCLC
Authorized Official - Prefix:MS
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:ELIZABETH MARIE
Authorized Official - Last Name:TARR
Authorized Official - Suffix:
Authorized Official - Credentials:IBCLC, BS, CAHPE
Authorized Official - Phone:410-490-1553
Mailing Address - Street 1:PO BOX 52
Mailing Address - Street 2:
Mailing Address - City:MILLINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:21651-0052
Mailing Address - Country:US
Mailing Address - Phone:410-656-4048
Mailing Address - Fax:410-928-5044
Practice Address - Street 1:205 GROFF RD
Practice Address - Street 2:
Practice Address - City:MILLINGTON
Practice Address - State:MD
Practice Address - Zip Code:21651-1613
Practice Address - Country:US
Practice Address - Phone:410-490-1553
Practice Address - Fax:410-928-5044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-05
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty