Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 174N00000X | Lactation Consultant |
NPI | 1326674664 |
---|---|
Provider Name | Carmen J Ricanek-Clinton |
First Address | Wilmington, NC 28412-8372 |
Second Address | Wilmington, NC 28412-8372 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2020 |
Last Update Date | 18/03/2020 |