Healthcare Provider Details

I. General information

NPI: 1073318952
Provider Name (Legal Business Name): WILD FIG LACTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2025
Last Update Date: 02/15/2025
Certification Date: 02/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5817 MERVILLE AVE
BALTIMORE MD
21215-4157
US

IV. Provider business mailing address

5817 MERVILLE AVE
BALTIMORE MD
21215-4157
US

V. Phone/Fax

Practice location:
  • Phone: 443-529-0322
  • Fax: 443-873-0417
Mailing address:
  • Phone: 443-529-0322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number
License Number State

VIII. Authorized Official

Name: ABIGAIL EISLEY
Title or Position: OWNER
Credential: RN, BSN, IBCLC
Phone: 443-529-0322