MEDICARE: MEDCITY LACTATION AND FEEDING SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WL0100X	Lactation Consultant (Registered Nurse)

General Provider Information

NPI Number	:	1871315689
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDCITY LACTATION AND FEEDING SERVICES LLC

Provider Business Mailing Address
First Line	:	4648 CASSIDY RIDGE DR NE
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55906-8431
Country	:	US
Telephone Number	:	507-291-9830
Fax Number	:	507-291-9824

Provider Business Practice Location Address
First Line	:	4648 CASSIDY RIDGE DR NE
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55906-8431
Country	:	US
Telephone Number	:	507-291-9830
Fax Number	:	507-291-9824

Authorized Official
Title or Position	:	OWNER
Name	:	MOLLY MUSTAFA
Credential	:	BSN, RN, IBCLC
Telephone Number	:	507-291-9830

Provider Enumeration Date	:	10/31/2024
Last Update Date	:	11/04/2024

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