Provider Demographics
NPI:1619716362
Name:WILDFLOWER LACTATION AND POSTPARTUM CARE
Entity type:Organization
Organization Name:WILDFLOWER LACTATION AND POSTPARTUM CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LACTATION CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:T'ERRAH
Authorized Official - Middle Name:N
Authorized Official - Last Name:JESSUP
Authorized Official - Suffix:
Authorized Official - Credentials:MPH, IBCLC
Authorized Official - Phone:336-536-6466
Mailing Address - Street 1:4000 OSSI CT STE 257
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-8827
Mailing Address - Country:US
Mailing Address - Phone:336-536-6466
Mailing Address - Fax:
Practice Address - Street 1:4000 OSSI CT STE 257
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-8827
Practice Address - Country:US
Practice Address - Phone:336-536-6466
Practice Address - Fax:336-819-5518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty