# AUTHENTIC BIRTH CENTER . WELLNESS COLLECTIVE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1669807707
- **Authorized official:** MRS. LANETTE JOY MCQUITTY LM, CPM (OWNER,)
- **Authorized official phone:** (414) 559-2229

## Contact information

- **Practice address:** 530 N 108TH PL, SUITE 100, WAUWATOSA, WI 53226-4253
- **Practice address phone:** (414) 559-2229
- **Mailing address:** 530 N 108TH PL, SUITE 100, WAUWATOSA, WI 53226-4253
- **Mailing address phone:** (414) 559-2229

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QB0400X | Birthing Clinic/Center | — | WI | Yes |

## Other

- **Enumeration date:** 09/09/2013
- **Last updated:** 09/09/2013