Provider Demographics
NPI:1013676394
Name:SOAK LACTATION
Entity Type:Organization
Organization Name:SOAK LACTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTANA
Authorized Official - Suffix:
Authorized Official - Credentials:RN, IBCLC, CLE, CBE
Authorized Official - Phone:815-540-3613
Mailing Address - Street 1:5426 MIDVALE DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-2326
Mailing Address - Country:US
Mailing Address - Phone:815-540-3613
Mailing Address - Fax:
Practice Address - Street 1:5426 MIDVALE DR UNIT A
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2326
Practice Address - Country:US
Practice Address - Phone:815-540-3613
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-14
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Multi-Specialty
No174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty