Provider Demographics
NPI:1063749083
Name:PREMIER LACTATION SERVICES, LLC
Entity type:Organization
Organization Name:PREMIER LACTATION SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PREMIER LACTATION SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:RN-IBCLC
Authorized Official - Phone:571-722-6450
Mailing Address - Street 1:5533 BELLE POND DR
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-1640
Mailing Address - Country:US
Mailing Address - Phone:571-722-6450
Mailing Address - Fax:
Practice Address - Street 1:5533 BELLE POND DR
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20120-1640
Practice Address - Country:US
Practice Address - Phone:571-722-6450
Practice Address - Fax:571-778-5048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-11
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA10999203163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty