Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 174N00000X | Lactation Consultant | L-135675 | |
Y | 174N00000X | Lactation Consultant | L-135675 | TX |
NPI | 1295371912 |
---|---|
Provider Name | Dawna Marie Mangrum |
First Address | San Antonio, TX 78238-3011 |
Second Address | San Antonio, TX 78238-3011 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2019 |
Last Update Date | 18/01/2020 |