Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L13482 |
NPI | 1366952657 |
---|---|
Provider Name | Ann Bennett |
First Address | Austin, TX 78749-4208 |
Second Address | Phoenix, MD 21131-1217 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2017 |
Last Update Date | 02/10/2017 |