Healthcare Provider Details

I. General information

NPI: 1649698044
Provider Name (Legal Business Name): MOTHER 2 MOTHER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2014
Last Update Date: 04/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 BANGOR ST
HOULTON ME
04730-1711
US

IV. Provider business mailing address

5 BANGOR ST
HOULTON ME
04730-1711
US

V. Phone/Fax

Practice location:
  • Phone: 207-538-7129
  • Fax:
Mailing address:
  • Phone: 207-538-7129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number51401
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number51401
License Number StateME

VIII. Authorized Official

Name: ERICA DAWN DAVIS ROCKWELL
Title or Position: SOLE PROPRIETOR
Credential: RN, IBCLC, DOULA
Phone: 207-538-7129