Provider Demographics
NPI:1689255812
Name:SWEET LACTATION CORPORATION
Entity Type:Organization
Organization Name:SWEET LACTATION CORPORATION
Other - Org Name:SWEET LACTATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:SWEET
Authorized Official - Suffix:
Authorized Official - Credentials:RN, IBCLC
Authorized Official - Phone:979-229-1175
Mailing Address - Street 1:2700 E VILLA MARIA RD
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2031
Mailing Address - Country:US
Mailing Address - Phone:979-977-6455
Mailing Address - Fax:979-977-6555
Practice Address - Street 1:2700 E VILLA MARIA RD
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2031
Practice Address - Country:US
Practice Address - Phone:979-977-6455
Practice Address - Fax:979-977-6555
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SWEET LACTATION CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-19
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty