Healthcare Provider Details

I. General information

NPI: 1063856045
Provider Name (Legal Business Name): TIFFANY NICOLE CARTER SKILLINGS LM, CPM, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2013
Last Update Date: 03/11/2020
Certification Date: 03/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 FOREST FALLS DR
YARMOUTH ME
04096-7005
US

IV. Provider business mailing address

40 FOREST FALLS DR
YARMOUTH ME
04096-7005
US

V. Phone/Fax

Practice location:
  • Phone: 207-517-0386
  • Fax: 207-560-9405
Mailing address:
  • Phone: 207-517-0386
  • Fax: 207-560-9405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberCPM650
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-136153
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: