Healthcare Provider Details

I. General information

NPI: 1265254874
Provider Name (Legal Business Name): MILK WITH TEA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2024
Last Update Date: 10/26/2024
Certification Date: 10/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6063 MOUNT MORIAH ROAD EXT STE 14-172
MEMPHIS TN
38115-2757
US

IV. Provider business mailing address

6063 MOUNT MORIAH ROAD EXT STE 14-172
MEMPHIS TN
38115-2757
US

V. Phone/Fax

Practice location:
  • Phone: 901-350-5270
  • Fax:
Mailing address:
  • Phone: 901-350-5270
  • 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: TALITA OSEGUERA
Title or Position: LACTATION CONSULTANT
Credential:
Phone: 310-430-5964