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General NPI Number Information
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NPI Number | 1871315689
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Entity Type | Organization
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Legal Business Name | MEDCITY LACTATION AND FEEDING SERVICES LLC
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Dates
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Enumeration Date | 10/31/2024
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 4648 CASSIDY RIDGE DR NE
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City | ROCHESTER
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State | MN
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Zip | 55906-8431
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Country | US
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Telephone | 507-291-9830
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Fax | 507-291-9824
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Provider Business Mailing Address
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Address Line | 4648 CASSIDY RIDGE DR NE
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City | ROCHESTER
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State | MN
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Zip | 55906-8431
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Country | US
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Telephone | 507-291-9830
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Fax | 507-291-9824
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Authorized Official
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Title or Position | OWNER
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Name | MOLLY MUSTAFA
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Credential | BSN, RN, IBCLC
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Telephone | 507-291-9830
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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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