Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant |
NPI | 1194127381 |
---|---|
Provider Name | Ann Marie Neeley |
First Address | Bloomington, IN 47401-7730 |
Second Address | Bloomington, IN 47401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2014 |
Last Update Date | 19/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10725776 | INTERNATIONAL BOARD CERTIFIED LACTATION CONSULTANT (01) |