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NPI Code Detail

MEDICARE: MOMMYS BEAUTIFUL SUNRISE INC

MEDICARE: MOMMYS BEAUTIFUL SUNRISE INC
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
1171400000XHealth & Wellness Coach
2174N00000XLactation Consultant (Non-RN)
3251B00000XCase Management Agency
4374J00000XDoula
5385H00000XRespite Care
6172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1346047164
Entity Type Code : Organization
Provider Name (Legal Business Name) : MOMMYS BEAUTIFUL SUNRISE INC
Provider Business Mailing Address
First Line : 2656 N TEUTONIA AVE # 6566
Second Line :
City : MILWAUKEE
State : WI
Zip : 53206-9998
Country : US
Telephone Number : 262-457-9815
Fax Number :
Provider Business Practice Location Address
First Line : 8430 W CAPITOL DR STE 3025
Second Line :
City : MILWAUKEE
State : WI
Zip : 53222-1846
Country : US
Telephone Number : 262-457-9815
Fax Number :
Authorized Official
Title or Position : EXECUTOR DIRECTOR
Name : DR. SHANICE BAQUET
Credential : HOLISTIC PR
Telephone Number : 262-457-9815
Provider Enumeration Date : 02/27/2025
Last Update Date : 07/14/2025

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