Healthcare Provider Details

I. General information

NPI: 1346047164
Provider Name (Legal Business Name): MOMMYS BEAUTIFUL SUNRISE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2025
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8430 W CAPITOL DR STE 3025
MILWAUKEE WI
53222-1846
US

IV. Provider business mailing address

2656 N TEUTONIA AVE # 6566
MILWAUKEE WI
53206-9998
US

V. Phone/Fax

Practice location:
  • Phone: 262-457-9815
  • Fax:
Mailing address:
  • Phone: 262-457-9815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. SHANICE BAQUET
Title or Position: EXECUTOR DIRECTOR
Credential: HOLISTIC PR
Phone: 262-457-9815