Provider Demographics
NPI:1619628229
Name:BIRTHING BOLDLY, LLC
Entity Type:Organization
Organization Name:BIRTHING BOLDLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LACTATION CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:SLADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-344-3839
Mailing Address - Street 1:187 LICK FORK CREEK RD
Mailing Address - Street 2:
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27320-7752
Mailing Address - Country:US
Mailing Address - Phone:336-344-3839
Mailing Address - Fax:
Practice Address - Street 1:187 LICK FORK CREEK RD
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-7752
Practice Address - Country:US
Practice Address - Phone:336-344-3839
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty