Provider Demographics
NPI:1659189942
Name:MELANATED MATERNITY ESSENTIALS LLC.
Entity type:Organization
Organization Name:MELANATED MATERNITY ESSENTIALS LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIRSTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:BIRTH DOULA
Authorized Official - Phone:405-934-3440
Mailing Address - Street 1:1777 S BURLINGTON BLVD UNIT 271
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98233-3223
Mailing Address - Country:US
Mailing Address - Phone:405-934-3440
Mailing Address - Fax:
Practice Address - Street 1:3114 SCOTLAND ALLEY
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273
Practice Address - Country:US
Practice Address - Phone:405-934-3440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MELANATED MATERNITY ESSENTIALS LLC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1447086681OtherINDIVIDUAL NPI