=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982490751
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MADE TO MOTHER LACTATION, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2025
-----------------------------------------------------
Last Update Date | 04/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 251 W CENTER ST
-----------------------------------------------------
City | HOLLY SPRINGS
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27540-5900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-480-1935
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1361
-----------------------------------------------------
City | HOLLY SPRINGS
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27540-1361
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-480-1935
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. SARA WILSON
-----------------------------------------------------
Credential | PA-C, CLC
-----------------------------------------------------
Telephone | 919-272-4776
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------