NPIMap

Organization Active NPI

Mommy's Manna, PLLC

  • Lactation Consultant (Registered Nurse)
  • Raeford, NC
National Provider Identifier
1801225503
Registry record updated Nov 4, 2013
On this page

Key facts

NPPES NPI Registry
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
Last updated
Nov 4, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2013

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, IBCLCNPI 1760964878
Title
Ceo
Phone
(336) 392-5384

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Lactation Consultant (Registered Nurse)Group: 193400000X SINGLE SPECIALTY GROUP 163WL0100X L-47283 NC Primary
Clinic/Center 261Q00000X L-47283 NC

Addresses

Primary practice location

205 Huntington Dr
Raeford, NC 28376-6352

Mailing address

205 Huntington Dr
Raeford, NC 28376-6352
Phone (336) 392-5384

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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": []
}

Other providers in Raeford, NC

Sources for this page

  • 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.