Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-16605 | VA |
NPI | 1306257761 |
---|---|
Provider Name | Cathryn Clark |
First Address | Austin, TX 78759-8661 |
Second Address | Austin, TX 78759-8661 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2014 |
Last Update Date | 19/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
L-16605 | IBLCE (01) | VA |