Healthcare Provider Details

I. General information

NPI: 1790380905
Provider Name (Legal Business Name): MORENIKE TYEHIMBA IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2020
Last Update Date: 09/16/2021
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 BARNARD ST # 300
SAVANNAH GA
31401-6746
US

IV. Provider business mailing address

1305 BARNARD ST # 300
SAVANNAH GA
31401-6746
US

V. Phone/Fax

Practice location:
  • Phone: 216-203-2554
  • Fax:
Mailing address:
  • Phone: 216-203-2554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberLC000150
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: