Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-110692 | MS |
NPI | 1164924304 |
---|---|
Provider Name | Bianca Todd Wooden |
First Address | Ocean Springs, MS 39564-5321 |
Second Address | Ocean Springs, MS 39564-5321 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2018 |
Last Update Date | 04/03/2018 |