Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant |
NPI | 1366659153 |
---|---|
Provider Name | Ann Marie Russell |
First Address | Poway, CA 92064-6432 |
Second Address | Poway, CA 92064-6432 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2007 |
Last Update Date | 30/04/2011 |