Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | 302308 | UT |
NPI | 1104414697 |
---|---|
Provider Name | Emily York |
First Address | Provo, UT 84606-4604 |
Second Address | Provo, UT 84606-4604 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2021 |
Last Update Date | 09/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
302308 | IBCLE (01) | UT |