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General NPI Number Information
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NPI Number | 1407361736
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Entity Type | Organization
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Legal Business Name | MOTHERS' MILK BANK OF MONTANA
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Dates
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Enumeration Date | 12/08/2017
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Last Update Date | 12/15/2017
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Provider Practice Location Address
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Address Line | 2825 STOCKYARD RD STE C1
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City | MISSOULA
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State | MT
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Zip | 59808-1502
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Country | US
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Telephone | 406-531-6789
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Fax | 888-287-1423
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Provider Business Mailing Address
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Address Line | 2825 STOCKYARD RD STE C1
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City | MISSOULA
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State | MT
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Zip | 59808-1502
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Country | US
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Telephone | 406-531-6789
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Fax | 888-287-1423
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JESSICA WELBORN
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Credential | PHD
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Telephone | 406-531-6789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number |
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License Number State |
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