Provider Demographics
NPI:1831589563
Name:MILK MAVEN LLC
Entity type:Organization
Organization Name:MILK MAVEN LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, LACTATION CONSULTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOSS
Authorized Official - Suffix:
Authorized Official - Credentials:IBCLC
Authorized Official - Phone:512-415-8627
Mailing Address - Street 1:PO BOX 7872
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78683-7872
Mailing Address - Country:US
Mailing Address - Phone:512-415-8627
Mailing Address - Fax:
Practice Address - Street 1:2918 WINCHESTER DR
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-7804
Practice Address - Country:US
Practice Address - Phone:512-415-8627
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty