Provider Demographics
NPI:1790380905
Name:TYEHIMBA, MORENIKE (IBCLC)
Entity Type:Individual
Prefix:
First Name:MORENIKE
Middle Name:
Last Name:TYEHIMBA
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 BARNARD ST # 300
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31401-6746
Mailing Address - Country:US
Mailing Address - Phone:216-203-2554
Mailing Address - Fax:
Practice Address - Street 1:1305 BARNARD ST # 300
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31401-6746
Practice Address - Country:US
Practice Address - Phone:216-203-2554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-03
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA374J00000X
GALC000150174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No374J00000XNursing Service Related ProvidersDoula