Healthcare Provider Details

I. General information

NPI: 1417428756
Provider Name (Legal Business Name): MOTHER'S MILK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 12/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64-778 PAELIALANUI STREET
KAMUELA HI
96743-2625
US

IV. Provider business mailing address

PO BOX 2625
KAMUELA HI
96743-2625
US

V. Phone/Fax

Practice location:
  • Phone: 808-887-6659
  • Fax:
Mailing address:
  • Phone: 808-887-6659
  • 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: ELIZABETH KEHAU KEALOHA
Title or Position: OWNER
Credential: RN, IBCLC
Phone: 808-887-6659