Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant |
NPI | 1003390725 |
---|---|
Provider Name | Beth Wilson |
First Address | Lima, OH 45805-2926 |
Second Address | Lima, OH 45805-2926 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2018 |
Last Update Date | 18/09/2018 |