MEDICARE: NEW MOMMY'S MATERNITY BREASTFEEDING & SUPPLIES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1093143117
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW MOMMY'S MATERNITY BREASTFEEDING & SUPPLIES

Provider Business Mailing Address
First Line	:	3291 DEL REY BLVD
Second Line	:	SUITE 6
City	:	LAS CRUCES
State	:	NM
Zip	:	88012-5045
Country	:	US
Telephone Number	:	575-525-9259
Fax Number	:

Provider Business Practice Location Address
First Line	:	3291 DEL REY BLVD
Second Line	:	SUITE 6
City	:	LAS CRUCES
State	:	NM
Zip	:	88012-5045
Country	:	US
Telephone Number	:	575-525-9259
Fax Number	:

Authorized Official
Title or Position	:	BUISNESS OWNER
Name	:	MRS. MARIA LORENA BROWN
Credential	:
Telephone Number	:	575-525-9259

Provider Enumeration Date	:	10/29/2013
Last Update Date	:	10/29/2013

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