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General NPI Number Information
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NPI Number | 1619628229
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Entity Type | Organization
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Legal Business Name | BIRTHING BOLDLY, LLC
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Dates
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Enumeration Date | 01/14/2022
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Last Update Date | 01/14/2022
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Provider Practice Location Address
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Address Line | 187 LICK FORK CREEK RD
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City | REIDSVILLE
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State | NC
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Zip | 27320-7752
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Country | US
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Telephone | 336-344-3839
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Fax |
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Provider Business Mailing Address
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Address Line | 187 LICK FORK CREEK RD
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City | REIDSVILLE
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State | NC
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Zip | 27320-7752
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Country | US
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Telephone | 336-344-3839
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Fax |
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Authorized Official
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Title or Position | OWNER/LACTATION CONSULTANT
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Name | TIFFANY SLADE
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Credential |
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Telephone | 336-344-3839
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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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