Healthcare Provider Details

I. General information

NPI: 1326782988
Provider Name (Legal Business Name): PURE MILK MOM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2022
Last Update Date: 04/20/2022
Certification Date: 04/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20526 N 94TH PL
SCOTTSDALE AZ
85255-6634
US

IV. Provider business mailing address

20526 N 94TH PL
SCOTTSDALE AZ
85255-6634
US

V. Phone/Fax

Practice location:
  • Phone: 701-446-8439
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name: MRS. GRACE NORTON
Title or Position: PRESIDENT, FOUNDER
Credential: MHI, RDN, IBCLC
Phone: 480-416-7295