Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-46770 | MN |
NPI | 1265854632 |
---|---|
Provider Name | Abby Boelter |
First Address | Saint Cloud, MN 56303-5000 |
Second Address | Saint Cloud, MN 56303-5000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2014 |
Last Update Date | 20/01/2014 |