Healthcare Provider Details

I. General information

NPI: 1316559040
Provider Name (Legal Business Name): STORK MATERNITY CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 08/24/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5848 MENLO DR
BATON ROUGE LA
70808-5047
US

IV. Provider business mailing address

5848 MENLO DR
BATON ROUGE LA
70808-5047
US

V. Phone/Fax

Practice location:
  • Phone: 225-341-2411
  • Fax:
Mailing address:
  • Phone: 225-341-2411
  • 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: LEAH FREDERICK
Title or Position: OWNER
Credential: RN
Phone: 225-341-2411