Provider Demographics
NPI:1467874925
Name:SIMPLY LACTATION, LLC
Entity Type:Organization
Organization Name:SIMPLY LACTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LACTATION CONSULTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAFIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOMIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN, IBCLC, FNP-C
Authorized Official - Phone:832-566-8949
Mailing Address - Street 1:7635 WESTMORELAND DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-3340
Mailing Address - Country:US
Mailing Address - Phone:281-658-3117
Mailing Address - Fax:
Practice Address - Street 1:7635 WESTMORELAND DR
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-3340
Practice Address - Country:US
Practice Address - Phone:281-658-3117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-16
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX744210163WL0100X
TXAP127524363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty