Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-109903 |
NPI | 1285178749 |
---|---|
Provider Name | Carolyn Canning |
First Address | Burbank, CA 91505-2704 |
Second Address | Burbank, CA 91505-2704 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2016 |
Last Update Date | 16/12/2016 |