Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-83686 | TX |
NPI | 1295190031 |
---|---|
Provider Name | Dana Weston |
First Address | Fort Worth, TX 76126-5295 |
Second Address | Fort Worth, TX 76126-5295 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2015 |
Last Update Date | 21/12/2015 |