Provider Demographics
NPI:1851863021
Name:THE MILKY MERMAID, LLC
Entity Type:Organization
Organization Name:THE MILKY MERMAID, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER, ORGANIZER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:BS, IBCLC
Authorized Official - Phone:919-210-8846
Mailing Address - Street 1:1910 ERIN CT
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-3551
Mailing Address - Country:US
Mailing Address - Phone:919-210-8846
Mailing Address - Fax:910-719-9019
Practice Address - Street 1:1910 ERIN CT
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-3551
Practice Address - Country:US
Practice Address - Phone:919-210-8846
Practice Address - Fax:910-719-9019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-27
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty