Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant |
NPI | 1154825396 |
---|---|
Provider Name | Emily Jensen |
First Address | Beaverton, OR 97008-7289 |
Second Address | Beaverton, OR 97008-7289 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2018 |
Last Update Date | 21/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
L-137581 | IBLCE-INTERNATIONAL BOARD OF LACTATION CONSULTANT EXAMINERS (01) |