Healthcare Provider Details

I. General information

NPI: 1144064361
Provider Name (Legal Business Name): GROUNDED LACTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2024
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 SHEPHERD ST
DURHAM NC
27701-3135
US

IV. Provider business mailing address

702 SHEPHERD ST
DURHAM NC
27701-3135
US

V. Phone/Fax

Practice location:
  • Phone: 919-491-5939
  • Fax: 984-287-7922
Mailing address:
  • Phone: 919-491-5939
  • Fax: 984-287-7922

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: EMILY SINK MOODY
Title or Position: OWNER
Credential: RN, IBCLC
Phone: 919-491-5939