MEDICARE: MILK WITH TEA

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	:	1265254874
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILK WITH TEA

Provider Business Mailing Address
First Line	:	6063 MOUNT MORIAH ROAD EXT STE 14-172
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38115-2757
Country	:	US
Telephone Number	:	901-350-5270
Fax Number	:

Provider Business Practice Location Address
First Line	:	6063 MOUNT MORIAH ROAD EXT STE 14-172
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38115-2757
Country	:	US
Telephone Number	:	901-350-5270
Fax Number	:

Authorized Official
Title or Position	:	LACTATION CONSULTANT
Name	:	TALITA OSEGUERA
Credential	:
Telephone Number	:	310-430-5964

Provider Enumeration Date	:	10/26/2024
Last Update Date	:	10/26/2024

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Directions to “MILK WITH TEA ” Practice Location

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