Provider Demographics
NPI:1023903796
Name:LOLLIES LACTATION
Entity type:Organization
Organization Name:LOLLIES LACTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MINTZ
Authorized Official - Suffix:
Authorized Official - Credentials:FNP, IBCLC
Authorized Official - Phone:336-816-9701
Mailing Address - Street 1:2323 WESTOVER DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3646
Mailing Address - Country:US
Mailing Address - Phone:336-816-9701
Mailing Address - Fax:
Practice Address - Street 1:318 INDERA MILLS CT
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-3383
Practice Address - Country:US
Practice Address - Phone:336-816-9701
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty