Provider Demographics
NPI:1952604894
Name:MY INFANT NEEDS,INC
Entity Type:Organization
Organization Name:MY INFANT NEEDS,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:SELF
Authorized Official - Suffix:
Authorized Official - Credentials:RN,BSN
Authorized Official - Phone:903-563-4765
Mailing Address - Street 1:407 COUNTY ROAD 1520
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-7378
Mailing Address - Country:US
Mailing Address - Phone:903-563-4765
Mailing Address - Fax:
Practice Address - Street 1:407 COUNTY ROAD 1520
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-7378
Practice Address - Country:US
Practice Address - Phone:903-563-4765
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-15
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11291501163WL0100X
TX716125163WM0102X
TX332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Multi-Specialty
No163WM0102XNursing Service ProvidersRegistered NurseMaternal NewbornGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty