Healthcare Provider Details

I. General information

NPI: 1063013548
Provider Name (Legal Business Name): CHRISTINE ANN HARDEN MOTT RN-NIC, IBCLC, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2020
Last Update Date: 11/03/2020
Certification Date: 11/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 MYRTLEWOOD DR
VESTAVIA HILLS AL
35216-5123
US

IV. Provider business mailing address

2225 MYRTLEWOOD DR
VESTAVIA HILLS AL
35216-5123
US

V. Phone/Fax

Practice location:
  • Phone: 410-336-4353
  • Fax:
Mailing address:
  • Phone: 410-336-4353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR-182375
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number1-163676
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-163122
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: