Healthcare Provider Details

I. General information

NPI: 1558283994
Provider Name (Legal Business Name): ILLUMINATED LACTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13094 NC HIGHWAY 50 STE B
SURF CITY NC
28445-6690
US

IV. Provider business mailing address

1415 N TOPSAIL DR
SURF CITY NC
28445-6793
US

V. Phone/Fax

Practice location:
  • Phone: 910-565-9841
  • Fax:
Mailing address:
  • Phone: 512-589-1476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name: SARAH HOGAN
Title or Position: OWNER
Credential:
Phone: 910-565-9841