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General NPI Number Information
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NPI Number | 1831567429
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Entity Type | Organization
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Legal Business Name | MULLICA HILL LACTATION LLC
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Dates
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Enumeration Date | 09/13/2015
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Last Update Date | 11/01/2016
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Provider Practice Location Address
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Address Line | 415 ERYN RD
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City | WENONAH
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State | NJ
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Zip | 08090-1609
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Country | US
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Telephone | 856-625-6099
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Fax |
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Provider Business Mailing Address
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Address Line | 415 ERYN RD
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City | WENONAH
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State | NJ
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Zip | 08090-1609
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Country | US
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Telephone | 856-625-6099
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Fax |
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Authorized Official
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Title or Position | LACTATION CONSULTANT
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Name | DANA SUZANNE MARRO
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Credential | BSN,RN,IBCLC
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Telephone | 856-625-6099
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 26NO11618000
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 0400646066
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License Number State | NJ
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