Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant |
NPI | 1194199653 |
---|---|
Provider Name | Devon Mullins |
First Address | Claremore, OK 74019-4241 |
Second Address | Claremore, OK 74019-4241 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2015 |
Last Update Date | 20/11/2015 |