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General NPI Number Information
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NPI Number | 1366280620
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Entity Type | Individual
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Provider Name | KENNEDY MAMO RN, IBCLC
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Gender | Female
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Dates
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Enumeration Date | 07/19/2024
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Last Update Date | 07/19/2024
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Provider Practice Location Address
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Address Line | 1701 SOUTH BLVD E STE 350
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City | ROCHESTER HILLS
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State | MI
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Zip | 48307-6117
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Country | US
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Telephone | 248-997-5805
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Fax |
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Provider Business Mailing Address
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Address Line | 6912 YORKTOWN LN
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City | SHELBY TOWNSHIP
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State | MI
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Zip | 48317-4265
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WL0100X
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Taxonomy Name | Lactation Consultant (Registered Nurse)
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License Number | 4707375748
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License Number State | MI
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