Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant |
NPI | 1033464649 |
---|---|
Provider Name | Dr. Jennie L Bever |
First Address | Mesa, AZ 85202-6324 |
Second Address | Mesa, AZ 85202-6324 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2012 |
Last Update Date | 19/07/2012 |