Provider Demographics
NPI:1497580948
Name:TIGER LILY COLLECTIVE LLC
Entity type:Organization
Organization Name:TIGER LILY COLLECTIVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ZOE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-246-7101
Mailing Address - Street 1:1575 S MOORLAND RD APT 208
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-1566
Mailing Address - Country:US
Mailing Address - Phone:414-246-7101
Mailing Address - Fax:
Practice Address - Street 1:10631 W LINCOLN AVE # 105
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-1240
Practice Address - Country:US
Practice Address - Phone:414-246-7101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Single Specialty