MEDICARE: LABOR OF LOVE PRENATAL COORDINATION SERVICES

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	261QH0100X	Health Service Clinic/Center
2	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1003489485
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LABOR OF LOVE PRENATAL COORDINATION SERVICES

Provider Business Mailing Address
First Line	:	4166 N 47TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-1529
Country	:	US
Telephone Number	:	414-595-4319
Fax Number	:

Provider Business Practice Location Address
First Line	:	4166 N 47TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-1529
Country	:	US
Telephone Number	:	414-595-4319
Fax Number	:

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	KEONIA PARKER
Credential	:
Telephone Number	:	414-595-4319

Provider Enumeration Date	:	07/22/2021
Last Update Date	:	09/24/2021

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