Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant |
NPI | 1093088437 |
---|---|
Provider Name | Dawn Stackhouse Dickerson |
First Address | San Diego, CA 92126-6109 |
Second Address | San Diego, CA 92126-6109 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2012 |
Last Update Date | 15/02/2012 |