Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | 11053511 |
NPI | 1235423963 |
---|---|
Provider Name | Angie Runyan |
First Address | Brookfield, IL 60513-1126 |
Second Address | Brookfield, IL 60513-1126 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2011 |
Last Update Date | 28/05/2011 |