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General NPI Number Information
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NPI Number | 1205658945
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Entity Type | Organization
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Legal Business Name | WILD MILK PLLC
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Dates
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Enumeration Date | 10/24/2024
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Last Update Date | 10/24/2024
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Provider Practice Location Address
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Address Line | 4946 E SAWMILL WAY
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City | BOISE
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State | ID
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Zip | 83716-6700
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Country | US
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Telephone | 209-765-2399
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Fax |
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Provider Business Mailing Address
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Address Line | 10960 W THREADGRASS ST
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City | STAR
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State | ID
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Zip | 83669-6334
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Country | US
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Telephone | 310-989-4820
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MAUREEN LEGASPI
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Credential | RN, IBCLC
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Telephone | 310-989-4820
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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