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General NPI Number Information
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NPI Number | 1023903796
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Entity Type | Organization
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Legal Business Name | LOLLIES LACTATION
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Dates
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Enumeration Date | 06/11/2025
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 318 INDERA MILLS CT
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City | WINSTON SALEM
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State | NC
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Zip | 27101-3383
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Country | US
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Telephone | 336-816-9701
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Fax |
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Provider Business Mailing Address
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Address Line | 2323 WESTOVER DR
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City | WINSTON SALEM
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State | NC
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Zip | 27103-3646
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Country | US
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Telephone | 336-816-9701
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KACIE MINTZ
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Credential | FNP, IBCLC
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Telephone | 336-816-9701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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