Provider Demographics
NPI:1306961511
Name:MILK MOMS, INC
Entity type:Organization
Organization Name:MILK MOMS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:JO
Authorized Official - Last Name:HEGNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-413-0129
Mailing Address - Street 1:13783 IBIS ST NW STE 200
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MN
Mailing Address - Zip Code:55304-7649
Mailing Address - Country:US
Mailing Address - Phone:763-413-0129
Mailing Address - Fax:763-413-9741
Practice Address - Street 1:13783 IBIS ST NW STE 200
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MN
Practice Address - Zip Code:55304-7649
Practice Address - Country:US
Practice Address - Phone:763-413-0129
Practice Address - Fax:763-413-9741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN56P99MIOtherBC BS PROVIDER ID
MN8200265OtherMEDICA PROVIDER ID
MN92729OtherHEALTH PARTNERS
MN040122005OtherPRIME WEST PROVIDER ID
MN160797OtherUCARE PROVIDER ID
MN367601300OtherMN DHS PROVIDER ID
MN040122005OtherMHP PROVIDER ID
MN56P99MIOtherBC BS PROVIDER ID