Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-83692 | PA |
NPI | 1184097826 |
---|---|
Provider Name | Brooke Azevedo |
First Address | Bryn Mawr, PA 19010-3844 |
Second Address | Bryn Mawr, PA 19010-3844 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2015 |
Last Update Date | 03/11/2015 |