Healthcare Provider Details

I. General information

NPI: 1013826981
Provider Name (Legal Business Name): THE MILK GROVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3357 WHITTIER DR
GREEN BAY WI
54311-8929
US

IV. Provider business mailing address

3357 WHITTIER DR
GREEN BAY WI
54311-8929
US

V. Phone/Fax

Practice location:
  • Phone: 920-362-2884
  • Fax:
Mailing address:
  • Phone: 920-362-2884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SERENITY MASON
Title or Position: OWNER
Credential: IBCLC
Phone: 920-362-2884