Healthcare Provider Details

I. General information

NPI: 1174089726
Provider Name (Legal Business Name): MOTHER'S DRUTHERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2019
Last Update Date: 02/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1536 N LARAMIE AVE
CHICAGO IL
60651-1407
US

IV. Provider business mailing address

1536 N LARAMIE AVE
CHICAGO IL
60651-1407
US

V. Phone/Fax

Practice location:
  • Phone: 708-359-9951
  • Fax:
Mailing address:
  • Phone: 708-359-9951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number
License Number State

VIII. Authorized Official

Name: RASHIDAH ABDULLAH
Title or Position: OWNER
Credential: APN, CNM, CBC, RN
Phone: 708-359-9951