Healthcare Provider Details

I. General information

NPI: 1841946639
Provider Name (Legal Business Name): A MOTHERS LINK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2022
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5628 KEELWOOD CT
GLEN ALLEN VA
23060-9242
US

IV. Provider business mailing address

5628 KEELWOOD CT
GLEN ALLEN VA
23060-9242
US

V. Phone/Fax

Practice location:
  • Phone: 804-688-5811
  • Fax: 804-533-1335
Mailing address:
  • Phone: 804-688-5811
  • Fax: 804-533-1335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateNULL

VIII. Authorized Official

Name: LESLIE TRULL WANYOIKE
Title or Position: FOUNDER/CEO
Credential:
Phone: 804-688-5811