Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 174N00000X | Lactation Consultant |
NPI | 1225596505 |
---|---|
Provider Name | Ebonie Karma Tudor |
First Address | North Babylon, NY 11703-1123 |
Second Address | North Babylon, NY 11703-1123 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2019 |
Last Update Date | 21/07/2020 |