Provider Demographics
NPI:1700545324
Name:BRILLIANT BIRTHING AND LACTATION, LLC
Entity Type:Organization
Organization Name:BRILLIANT BIRTHING AND LACTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPURATA
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP, IBCLC
Authorized Official - Phone:240-350-4525
Mailing Address - Street 1:5083 REIGATE CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-6821
Mailing Address - Country:US
Mailing Address - Phone:240-350-4525
Mailing Address - Fax:
Practice Address - Street 1:5083 REIGATE CT
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-6821
Practice Address - Country:US
Practice Address - Phone:240-350-4525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-10
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1609245018Medicaid