Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant |
NPI | 1366110819 |
---|---|
Provider Name | Arisalee June Sorem |
First Address | Canton, TX 75103-1140 |
Second Address | Canton, TX 75103-1140 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2021 |
Last Update Date | 31/08/2021 |