Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-132313 | AZ |
NPI | 1174000145 |
---|---|
Provider Name | Crystal Winstead-Heinecke |
First Address | Gilbert, AZ 85234-3422 |
Second Address | Tempe, AZ 85284-2100 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2018 |
Last Update Date | 23/07/2018 |