MEDICARE: EXCEPTIONAL PRENATAL 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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1114690617
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXCEPTIONAL PRENATAL SERVICES LLC

Provider Business Mailing Address
First Line	:	5252 N 65TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53218-3008
Country	:	US
Telephone Number	:	141-488-8962
Fax Number	:

Provider Business Practice Location Address
First Line	:	5252 N 65TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53218-3008
Country	:	US
Telephone Number	:	414-888-9627
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. DEANYA LAKESHA BROWN
Credential	:
Telephone Number	:	414-888-9627

Provider Enumeration Date	:	07/29/2021
Last Update Date	:	07/29/2021

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