Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | ALPP-237149 | OK |
NPI | 1184140659 |
---|---|
Provider Name | Amy Lauren Walton |
First Address | Tulsa, OK 74135-4677 |
Second Address | Tulsa, OK 74135-4677 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2017 |
Last Update Date | 16/08/2017 |