Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | 11152541 | NC |
NPI | 1336409770 |
---|---|
Provider Name | Elizabeth Perry Long |
First Address | Charlotte, NC 28269-1405 |
Second Address | Charlotte, NC 28269-1405 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2012 |
Last Update Date | 19/05/2012 |