MEDICARE: MOTHER2MOTHER LLC

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1720608953
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOTHER2MOTHER LLC

Provider Business Mailing Address
First Line	:	2142 N 15TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53205-1209
Country	:	US
Telephone Number	:	414-588-8726
Fax Number	:

Provider Business Practice Location Address
First Line	:	2142 N 15TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53205-1209
Country	:	US
Telephone Number	:	414-588-8726
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	ANNIE PAULINE ROBINSON
Credential	:
Telephone Number	:	414-588-8726

Provider Enumeration Date	:	04/17/2020
Last Update Date	:	04/17/2020

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Directions to “MOTHER2MOTHER LLC ” Practice Location

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