Provider Demographics
NPI:1124447784
Name:MODERN MAMA LACTATION CONSULTING
Entity type:Organization
Organization Name:MODERN MAMA LACTATION CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED LACTATION CONSULTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MAJORS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, IBCLC
Authorized Official - Phone:919-413-1782
Mailing Address - Street 1:2807 MEBANE LN
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-7986
Mailing Address - Country:US
Mailing Address - Phone:919-413-1782
Mailing Address - Fax:
Practice Address - Street 1:2807 MEBANE LN
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-7986
Practice Address - Country:US
Practice Address - Phone:919-413-1782
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL-32748163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC192998OtherRN LICENSE
NCL-32748OtherIBCLC