Healthcare Provider Details

I. General information

NPI: 1538584719
Provider Name (Legal Business Name): THE MOTHER BABY CONNECTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2014
Last Update Date: 02/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 64 BOX 100-22
YELLOW SPRING WV
26865-9506
US

IV. Provider business mailing address

HC 64 BOX 100-22
YELLOW SPRING WV
26865-9506
US

V. Phone/Fax

Practice location:
  • Phone: 703-501-8983
  • Fax:
Mailing address:
  • Phone: 703-501-8983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number0001092828
License Number StateVA

VIII. Authorized Official

Name: LAURIE CLARK-GRUBBS
Title or Position: LACTATION CONSULTANT
Credential: RN, IBCLC
Phone: 703-501-8983