=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215803994
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MANOA BREASTFEEDING SUPPORT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/11/2025
-----------------------------------------------------
Last Update Date | 10/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3542 KUMUWAI PL
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96822-1115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-258-4211
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3542 KUMUWAI PL
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96822-1115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | RN IBCLC
-----------------------------------------------------
Name | NAOMI BROWN
-----------------------------------------------------
Credential | RN IBCLC
-----------------------------------------------------
Telephone | 808-258-4211
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WL0100X
-----------------------------------------------------
Taxonomy Name | Lactation Consultant (Registered Nurse)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------