Healthcare Provider Details

I. General information

NPI: 1528865474
Provider Name (Legal Business Name): THE MAMA COACH-KARISSA MARTIN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2025
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38532 SADDLE MOUNTAIN LN
CRAWFORD CO
81415-9128
US

IV. Provider business mailing address

38532 SADDLE MOUNTAIN LN
CRAWFORD CO
81415-9128
US

V. Phone/Fax

Practice location:
  • Phone: 970-921-9978
  • Fax:
Mailing address:
  • Phone: 970-921-9978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number
License Number State

VIII. Authorized Official

Name: MRS. KARISSA J. MARTIN
Title or Position: OWNER
Credential: RN, IBCLC
Phone: 970-921-9978