Healthcare Provider Details

I. General information

NPI: 1972998599
Provider Name (Legal Business Name): 402 FRONT ST. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2015
Last Update Date: 04/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E PEMBREY DR
WILMINGTON DE
19803-2004
US

IV. Provider business mailing address

402 E FRONT ST
WILMINGTON DE
19801-3956
US

V. Phone/Fax

Practice location:
  • Phone: 281-797-7222
  • Fax:
Mailing address:
  • Phone: 281-797-7222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-26371
License Number State

VIII. Authorized Official

Name: MS. SHARON M. SCHOPFER
Title or Position: LACTATION CONSULTANT
Credential: BS, IBCLC, RLC
Phone: 302-304-3800