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General NPI Number Information
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NPI Number | 1962275552
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Entity Type | Organization
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Legal Business Name | ORIGINAL MAMI LLC
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Dates
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Enumeration Date | 11/06/2023
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Last Update Date | 07/18/2025
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Provider Practice Location Address
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Address Line | 7 E PALO VERDE ST STE 10
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City | GILBERT
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State | AZ
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Zip | 85296-1045
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Country | US
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Telephone | 480-618-7219
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Fax | 480-885-2402
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Provider Business Mailing Address
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Address Line | 7 E PALO VERDE ST STE 10
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City | GILBERT
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State | AZ
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Zip | 85296-1045
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Country | US
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Telephone | 480-203-1136
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STEPHANIE CELIS
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Credential | RN, IBCLC
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Telephone | 480-203-1136
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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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 | 163WL0100X
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Taxonomy Name | Lactation Consultant (Registered Nurse)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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