Provider Demographics
NPI:1174862791
Name:EDUCATED MOMMY
Entity Type:Organization
Organization Name:EDUCATED MOMMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FONDER
Authorized Official - Suffix:
Authorized Official - Credentials:RN IBCLC LCCE
Authorized Official - Phone:605-215-1889
Mailing Address - Street 1:207 W 37TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-5703
Mailing Address - Country:US
Mailing Address - Phone:605-215-1889
Mailing Address - Fax:
Practice Address - Street 1:207 W 37TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-5703
Practice Address - Country:US
Practice Address - Phone:605-215-1889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-01
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies