Healthcare Provider Details

I. General information

NPI: 1609442599
Provider Name (Legal Business Name): WISCO LACTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2021
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 N 108TH PL STE 203
WAUWATOSA WI
53226-4253
US

IV. Provider business mailing address

530 N 108TH PL STE 203
WAUWATOSA WI
53226-4253
US

V. Phone/Fax

Practice location:
  • Phone: 414-249-4420
  • Fax:
Mailing address:
  • Phone: 414-249-4420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ASHLEIGH RICHMOND
Title or Position: OWNER
Credential:
Phone: 262-909-2371