Healthcare Provider Details

I. General information

NPI: 1558299685
Provider Name (Legal Business Name): LOLLIES LACTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 INDERA MILLS CT
WINSTON SALEM NC
27101-3383
US

IV. Provider business mailing address

2323 WESTOVER DR
WINSTON SALEM NC
27103-3646
US

V. Phone/Fax

Practice location:
  • Phone: 336-816-9701
  • Fax:
Mailing address:
  • Phone: 336-816-9701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KACIE MINTZ
Title or Position: OWNER
Credential: FNP, IBCLC
Phone: 336-816-9701