Healthcare Provider Details

I. General information

NPI: 1598665267
Provider Name (Legal Business Name): MOMMY'S OWN MILK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2026
Last Update Date: 11/06/2026
Certification Date: 11/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 32ND AVE S STE 240
FARGO ND
58103-6118
US

IV. Provider business mailing address

7401 WILES RD STE 322
CORAL SPRINGS FL
33067-2036
US

V. Phone/Fax

Practice location:
  • Phone: 954-507-7686
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name: NEENA PATEL
Title or Position: MEMBER
Credential:
Phone: 954-507-7686