Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | 326752 | IA |
NPI | 1336732122 |
---|---|
Provider Name | Elizabeth Jo Watkins |
First Address | Indianola, IA 50125-0076 |
Second Address | West Des Moines, IA 50266-1807 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2021 |
Last Update Date | 12/02/2021 |