Provider Demographics
NPI:1265239347
Name:BOOBOLOGY WITH DR. MOMO
Entity type:Organization
Organization Name:BOOBOLOGY WITH DR. MOMO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MISTI
Authorized Official - Middle Name:D
Authorized Official - Last Name:SCHNEIDEWIND
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN, FNP-C
Authorized Official - Phone:850-865-0406
Mailing Address - Street 1:105 OAKWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-4242
Mailing Address - Country:US
Mailing Address - Phone:850-865-0406
Mailing Address - Fax:
Practice Address - Street 1:4591 E HIGHWAY 20 STE 202
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-8845
Practice Address - Country:US
Practice Address - Phone:850-865-0406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty