Healthcare Provider Details

I. General information

NPI: 1164172219
Provider Name (Legal Business Name): MILK IT LACTATION SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 03/23/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9600 ADINA LN NW
ALBUQUERQUE NM
87114-5263
US

IV. Provider business mailing address

9600 ADINA LN NW
ALBUQUERQUE NM
87114-5263
US

V. Phone/Fax

Practice location:
  • Phone: 505-730-7066
  • Fax:
Mailing address:
  • Phone: 505-730-7066
  • 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: CONDOLA GARRETT
Title or Position: OWNER
Credential: RN IBCLC
Phone: 505-730-7066