Provider Demographics
NPI:1649698044
Name:MOTHER 2 MOTHER
Entity type:Organization
Organization Name:MOTHER 2 MOTHER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:DAVIS ROCKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN, IBCLC, DOULA
Authorized Official - Phone:207-538-7129
Mailing Address - Street 1:5 BANGOR ST
Mailing Address - Street 2:
Mailing Address - City:HOULTON
Mailing Address - State:ME
Mailing Address - Zip Code:04730-1711
Mailing Address - Country:US
Mailing Address - Phone:207-538-7129
Mailing Address - Fax:
Practice Address - Street 1:5 BANGOR ST
Practice Address - Street 2:
Practice Address - City:HOULTON
Practice Address - State:ME
Practice Address - Zip Code:04730-1711
Practice Address - Country:US
Practice Address - Phone:207-538-7129
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-02
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME51401374J00000X, 163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Multi-Specialty
No374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty