Mommy'S Manna, PLLC

Primary specialty

Lactation Consultant (Registered Nurse)Taxonomy code 163WL0100X

License

L-47283 Issued in NC

Legal business name

MOMMY'S MANNA, PLLC

Practice address

205 Huntington Dr
Raeford, NC 28376-6352

Phone

(336) 392-5384

NPI assigned

Nov 4, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Dietra Ra'Chel Dalton, RN, BSN, IBCLC

Title

Ceo

Phone

(336) 392-5384

Specialties & licenses 2

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1383523200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1383523200000",
    "number": "1801225503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 HUNTINGTON DR",
            "city": "RAEFORD",
            "state": "NC",
            "postal_code": "283766352",
            "telephone_number": "336-392-5384"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 HUNTINGTON DR",
            "city": "RAEFORD",
            "state": "NC",
            "postal_code": "283766352",
            "telephone_number": "336-392-5384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOMMY'S MANNA, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-04",
        "last_updated": "2013-11-04",
        "status": "A",
        "authorized_official_last_name": "DALTON",
        "authorized_official_first_name": "DIETRA",
        "authorized_official_middle_name": "RA'CHEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "336-392-5384",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN, BSN, IBCLC"
    },
    "taxonomies": [
        {
            "code": "163WL0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Registered Nurse, Lactation Consultant",
            "state": "NC",
            "license": "L-47283",
            "primary": true
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NC",
            "license": "L-47283",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Raeford, NC
• Lactation Consultant (Registered Nurse) in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.