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NPI Code Detail

MEDICARE: MOTHERHOOD UNTAMED

MEDICARE: MOTHERHOOD UNTAMED
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
1174N00000XLactation Consultant (Non-RN)

General Provider Information

NPI Number : 1093543134
Entity Type Code : Organization
Provider Name (Legal Business Name) : MOTHERHOOD UNTAMED
Provider Business Mailing Address
First Line : 2718 STOCKBURY DR
Second Line :
City : FORT COLLINS
State : CO
Zip : 80525-9696
Country : US
Telephone Number : 970-219-0171
Fax Number :
Provider Business Practice Location Address
First Line : 2601 S LEMAY AVE STE 35
Second Line :
City : FORT COLLINS
State : CO
Zip : 80525-2296
Country : US
Telephone Number : 970-235-0045
Fax Number :
Authorized Official
Title or Position : OWNER
Name : ANGELA DAS
Credential : IBCLC
Telephone Number : 970-235-0045
Provider Enumeration Date : 07/22/2024
Last Update Date : 05/06/2026

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Directions to “MOTHERHOOD UNTAMED ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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