Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant |
NPI | 1003183229 |
---|---|
Provider Name | Elaine Renee Rose |
First Address | Coon Rapids, MN 55433-1754 |
Second Address | Coon Rapids, MN 55433-1754 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2011 |
Last Update Date | 17/11/2011 |