Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-106475 | ID |
NPI | 1225614241 |
---|---|
Provider Name | Cassandra Natasha Mackiewicz |
First Address | Boise, ID 83704-5318 |
Second Address | Boise, ID 83704-5318 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2021 |
Last Update Date | 20/03/2021 |