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General NPI Number Information
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NPI Number | 1013676394
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Entity Type | Organization
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Legal Business Name | SOAK LACTATION
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Dates
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Enumeration Date | 12/14/2021
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Last Update Date | 07/07/2022
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Provider Practice Location Address
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Address Line | 5426 MIDVALE DR UNIT A
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City | ROCKFORD
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State | IL
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Zip | 61108-2326
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Country | US
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Telephone | 815-540-3613
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Fax |
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Provider Business Mailing Address
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Address Line | 5426 MIDVALE DR UNIT A
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City | ROCKFORD
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State | IL
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Zip | 61108-2326
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Country | US
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Telephone | 815-540-3613
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NICOLE SANTANA
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Credential | RN, IBCLC, CLE, CBE
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Telephone | 815-540-3613
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174N00000X
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Taxonomy Name | Lactation Consultant (Non-RN)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 163WL0100X
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Taxonomy Name | Lactation Consultant (Registered Nurse)
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License Number |
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License Number State |
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