Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant |
NPI | 1093130445 |
---|---|
Provider Name | Crystal Lee |
First Address | Tempe, AZ 85282-4844 |
Second Address | Tempe, AZ 85282-4844 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2014 |
Last Update Date | 21/02/2014 |