Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | MW286 | FL |
NPI | 1134519507 |
---|---|
Provider Name | Audrey Luck |
First Address | Dunedin, FL 34698-5763 |
Second Address | Dunedin, FL 34698-5763 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2015 |
Last Update Date | 23/01/2015 |