Healthcare Provider Details

I. General information

NPI: 1902793219
Provider Name (Legal Business Name): MAL'S MILKY WAY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2025
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 N BALLARD RD STE C
APPLETON WI
54911-9002
US

IV. Provider business mailing address

3301 N BALLARD RD STE C
APPLETON WI
54911-9002
US

V. Phone/Fax

Practice location:
  • Phone: 920-609-8532
  • Fax: 920-609-8532
Mailing address:
  • Phone: 920-609-8532
  • Fax: 920-609-8532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ABBEY MCLAUGHLIN
Title or Position: OWNER/LACTATION CONSULTANT
Credential: RN, BSN, IBCLC
Phone: 920-609-8532