Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 174N00000X | Lactation Consultant | L-104867 | VA |
NPI | 1053793158 |
---|---|
Provider Name | Christine Allegra Gast |
First Address | Fort Walton Beach, FL 32547-5027 |
Second Address | Fort Walton Beach, FL 32547-5027 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2015 |
Last Update Date | 05/09/2019 |