MEDICARE: WHOLE BRAIN WHOLE BODY

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	174N00000X	Lactation Consultant (Non-RN)

General Provider Information

NPI Number	:	1255055133
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHOLE BRAIN WHOLE BODY

Provider Business Mailing Address
First Line	:	112 W 27TH ST STE 402
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10001-6241
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	112 W 27TH ST STE 402
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10001-6241
Country	:	US
Telephone Number	:	646-535-8633
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NINA KAUR
Credential	:	IBCLC
Telephone Number	:	465-358-6336

Provider Enumeration Date	:	10/03/2022
Last Update Date	:	10/03/2022

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