Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 174N00000X | Lactation Consultant | L-12847 | IA |
NPI | 1174924856 |
---|---|
Provider Name | Carole Hahn |
First Address | Bloomington, IL 61701-1525 |
Second Address | Bloomington, IL 61701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2014 |
Last Update Date | 29/06/2018 |