Healthcare Provider Details

I. General information

NPI: 1003489485
Provider Name (Legal Business Name): LABOR OF LOVE PRENATAL COORDINATION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2021
Last Update Date: 09/24/2021
Certification Date: 09/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4166 N 47TH ST
MILWAUKEE WI
53216-1529
US

IV. Provider business mailing address

4166 N 47TH ST
MILWAUKEE WI
53216-1529
US

V. Phone/Fax

Practice location:
  • Phone: 414-595-4319
  • Fax:
Mailing address:
  • Phone: 414-595-4319
  • 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 Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KEONIA PARKER
Title or Position: OWNER/OPERATOR
Credential:
Phone: 414-595-4319