MEDICARE: HEY MAMA LACTATION AND PERINATAL CARE

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	174N00000X	Lactation Consultant (Non-RN)

General Provider Information

NPI Number	:	1649819822
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEY MAMA LACTATION AND PERINATAL CARE

Provider Business Mailing Address
First Line	:	38 LINCOLN DR
Second Line	:
City	:	LAUREL SPRINGS
State	:	NJ
Zip	:	08021-2856
Country	:	US
Telephone Number	:	856-906-6504
Fax Number	:

Provider Business Practice Location Address
First Line	:	38 LINCOLN DR
Second Line	:
City	:	LAUREL SPRINGS
State	:	NJ
Zip	:	08021-2856
Country	:	US
Telephone Number	:	856-906-6504
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER/
Name	:	CHANELLE D ANDREWS
Credential	:
Telephone Number	:	856-906-6504

Provider Enumeration Date	:	01/05/2020
Last Update Date	:	01/05/2020

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