Provider Demographics
NPI:1801427927
Name:CENTRAL CAROLINA LACTATION CONSULTANT PLLC
Entity type:Organization
Organization Name:CENTRAL CAROLINA LACTATION CONSULTANT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LACTATION CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:JANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOPTAW
Authorized Official - Suffix:
Authorized Official - Credentials:BSN RN IBCLC
Authorized Official - Phone:336-493-8829
Mailing Address - Street 1:5374 TIMBER TRL
Mailing Address - Street 2:
Mailing Address - City:RANDLEMAN
Mailing Address - State:NC
Mailing Address - Zip Code:27317-8293
Mailing Address - Country:US
Mailing Address - Phone:336-633-9433
Mailing Address - Fax:
Practice Address - Street 1:5374 TIMBER TRL
Practice Address - Street 2:
Practice Address - City:RANDLEMAN
Practice Address - State:NC
Practice Address - Zip Code:27317-8293
Practice Address - Country:US
Practice Address - Phone:336-633-9433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty