=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356150098
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FLOURISHING MAMA COMPANY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/07/2025
-----------------------------------------------------
Last Update Date | 01/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2610 SMOOTH ALDER ST N
-----------------------------------------------------
City | GAMBRILLS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21054-1365
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-695-7041
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2610 SMOOTH ALDER ST N APT 104
-----------------------------------------------------
City | GAMBRILLS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21054-1365
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-595-4810
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | GABRIELL GARNER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 202-695-7041
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374J00000X
-----------------------------------------------------
Taxonomy Name | Doula
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------