Provider Demographics
NPI:1295450484
Name:CREDO LACTATION LLC
Entity type:Organization
Organization Name:CREDO LACTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN, IBCLC
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:SOPP
Authorized Official - Suffix:
Authorized Official - Credentials:RN, IBCLC
Authorized Official - Phone:919-219-2680
Mailing Address - Street 1:1800 MISTY HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-6222
Mailing Address - Country:US
Mailing Address - Phone:919-219-2680
Mailing Address - Fax:
Practice Address - Street 1:1800 MISTY HOLLOW LN
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-6222
Practice Address - Country:US
Practice Address - Phone:919-219-2680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-10
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Multi-Specialty