Healthcare Provider Details

I. General information

NPI: 1174914097
Provider Name (Legal Business Name): MOM BABY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2015
Last Update Date: 02/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1912 WEBSTER ST
PHILADELPHIA PA
19146-1828
US

IV. Provider business mailing address

1912 WEBSTER ST
PHILADELPHIA PA
19146-1828
US

V. Phone/Fax

Practice location:
  • Phone: 610-322-4932
  • Fax:
Mailing address:
  • Phone: 610-322-4932
  • 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: ROSALIE E KMIEC
Title or Position: LACTATION CONSULTANT
Credential: RN, IBCLC
Phone: 610-322-4932