Healthcare Provider Details

I. General information

NPI: 1942074703
Provider Name (Legal Business Name): AN INSPIRATIONAL LOVER PRENATAL CARE AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2023
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10520 N BAEHR RD STE M
MEQUON WI
53092-6701
US

IV. Provider business mailing address

10520 N BAEHR RD STE M
MEQUON WI
53092-6701
US

V. Phone/Fax

Practice location:
  • Phone: 414-202-6350
  • Fax:
Mailing address:
  • Phone: 414-202-6350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY MOORE
Title or Position: OWNER
Credential:
Phone: 414-202-6350