MEDICARE: MILK IT LACTATION SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WL0100X	Lactation Consultant (Registered Nurse)

General Provider Information

NPI Number	:	1164172219
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILK IT LACTATION SERVICES LLC

Provider Business Mailing Address
First Line	:	9600 ADINA LN NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-5263
Country	:	US
Telephone Number	:	505-730-7066
Fax Number	:

Provider Business Practice Location Address
First Line	:	9600 ADINA LN NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-5263
Country	:	US
Telephone Number	:	505-730-7066
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CONDOLA GARRETT
Credential	:	RN IBCLC
Telephone Number	:	505-730-7066

Provider Enumeration Date	:	03/23/2022
Last Update Date	:	03/23/2022

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