Provider Demographics
NPI:1386322493
Name:MOTHER NURTURE PRENATAL CARE COORDINATION SERVICES LLC
Entity type:Organization
Organization Name:MOTHER NURTURE PRENATAL CARE COORDINATION SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:CATHERINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-345-0134
Mailing Address - Street 1:4524 W. ROOSEVELT DRIVE
Mailing Address - Street 2:#2
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-2458
Mailing Address - Country:US
Mailing Address - Phone:414-345-0134
Mailing Address - Fax:
Practice Address - Street 1:4524 W. ROOSEVELT DRIVE
Practice Address - Street 2:#2
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-2458
Practice Address - Country:US
Practice Address - Phone:414-345-0134
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-10
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty