Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 174N00000X | Lactation Consultant |
NPI | 1225599871 |
---|---|
Provider Name | Erin Kaleena Fortuna |
First Address | Molalla, OR 97038-9005 |
Second Address | Molalla, OR 97038-9005 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2019 |
Last Update Date | 27/03/2019 |