Provider Demographics
NPI:1790342129
Name:OKLAHOMA MOTHERS' MILK BANK
Entity Type:Organization
Organization Name:OKLAHOMA MOTHERS' MILK BANK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANNEL
Authorized Official - Suffix:
Authorized Official - Credentials:MPH, IBCLC
Authorized Official - Phone:405-297-5683
Mailing Address - Street 1:901 N LINCOLN BLVD STE 330
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-3211
Mailing Address - Country:US
Mailing Address - Phone:405-297-5683
Mailing Address - Fax:405-297-5637
Practice Address - Street 1:901 N LINCOLN BLVD STE 330
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-3211
Practice Address - Country:US
Practice Address - Phone:405-297-5683
Practice Address - Fax:405-297-5637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition