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Organization

MOMMY'S MANNA, PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. DIETRA RA'CHEL DALTON RN, BSN, IBCLC (CEO)
(336) 392-5384
Entity
Organization

Contact information

Practice address
205 HUNTINGTON DR, RAEFORD, NC 28376-6352
(336) 392-5384
Mailing address
205 HUNTINGTON DR, RAEFORD, NC 28376-6352
(336) 392-5384

Taxonomy

Speciality
Code
Description
License number
State
163WL0100X
Lactation Consultant (Registered Nurse)
Primary
L-47283
NC
261Q00000X
Clinic/Center
L-47283
NC

Other

Enumeration date
11/04/2013
Last updated
11/04/2013
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