Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-96583 |
NPI | 1144650623 |
---|---|
Provider Name | Brandi Jordan |
First Address | Arlington, TN 38002-1521 |
Second Address | Arlington, TN 38002-1521 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2013 |
Last Update Date | 09/12/2021 |